Provider Demographics
NPI:1790259042
Name:MANZ PASTORAL COUNSELING LLC
Entity Type:Organization
Organization Name:MANZ PASTORAL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:515-227-0334
Mailing Address - Street 1:106 TAFT ST N
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-1770
Mailing Address - Country:US
Mailing Address - Phone:515-227-0334
Mailing Address - Fax:
Practice Address - Street 1:728 1ST AVE N
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-0466
Practice Address - Country:US
Practice Address - Phone:515-227-0334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)