Provider Demographics
NPI:1336380963
Name:MANNER, KEITH DEAN (MS)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:DEAN
Last Name:MANNER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 491750
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-1750
Mailing Address - Country:US
Mailing Address - Phone:530-722-9957
Mailing Address - Fax:530-722-9294
Practice Address - Street 1:1170 INDUSTRIAL ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0734
Practice Address - Country:US
Practice Address - Phone:530-722-9957
Practice Address - Fax:530-722-9294
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38104106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist