Provider Demographics
NPI:1821477373
Name:MCMANUS, MELISSA JILL (LMFT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JILL
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-3215
Mailing Address - Country:US
Mailing Address - Phone:724-880-0138
Mailing Address - Fax:
Practice Address - Street 1:1215 N GREENGATE RD STE D
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-4081
Practice Address - Country:US
Practice Address - Phone:724-832-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000745106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist