Provider Demographics
NPI:1801370119
Name:MANUS, LESHAWN
Entity Type:Individual
Prefix:
First Name:LESHAWN
Middle Name:
Last Name:MANUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S HEATHERWILDE BLVD UNIT 2136
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78691-3987
Mailing Address - Country:US
Mailing Address - Phone:512-698-3925
Mailing Address - Fax:
Practice Address - Street 1:1704 BRANDON KELLER CT
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2959
Practice Address - Country:US
Practice Address - Phone:512-698-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities