Provider Demographics
NPI:1972030039
Name:MANZ, SAMUEL BENJAMIN (LPC)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:BENJAMIN
Last Name:MANZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MC DONALD PIKE
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-9239
Mailing Address - Country:US
Mailing Address - Phone:419-399-3636
Mailing Address - Fax:419-399-5915
Practice Address - Street 1:501 MC DONALD PIKE
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-9239
Practice Address - Country:US
Practice Address - Phone:419-399-3636
Practice Address - Fax:419-399-5915
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1200153101YP2500X
OHOH1260965101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional