Provider Demographics
NPI:1710952221
Name:MANJARRES AND ASSOCIATES, INC
Entity Type:Organization
Organization Name:MANJARRES AND ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RODRIGO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANJARRES
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-360-8860
Mailing Address - Street 1:135 N GREENLEAF ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3393
Mailing Address - Country:US
Mailing Address - Phone:847-360-8860
Mailing Address - Fax:847-360-8864
Practice Address - Street 1:135 N GREENLEAF ST
Practice Address - Street 2:SUITE 201
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3393
Practice Address - Country:US
Practice Address - Phone:847-360-8860
Practice Address - Fax:847-360-8864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-18
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IL180002842101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty