Provider Demographics
NPI:1295917391
Name:MANNING, MICHELLE MARIE (MA, MFTI,)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:MANNING
Suffix:
Gender:F
Credentials:MA, MFTI,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17634 LOS ALIMOS ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-4618
Mailing Address - Country:US
Mailing Address - Phone:818-365-2388
Mailing Address - Fax:818-365-9488
Practice Address - Street 1:17634 LOS ALIMOS ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-4618
Practice Address - Country:US
Practice Address - Phone:818-365-2388
Practice Address - Fax:818-365-9488
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 44231106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist