Provider Demographics
NPI:1265944672
Name:MANNING, MEGAN (MA, LMFT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:MOST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5232 PORCHLIGHT RDG.
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129
Mailing Address - Country:US
Mailing Address - Phone:651-341-0143
Mailing Address - Fax:
Practice Address - Street 1:475 CLEVELAND AVE. N.
Practice Address - Street 2:SUITE 316
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-330-3434
Practice Address - Fax:651-330-3581
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2893106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist