Provider Demographics
NPI:1457307290
Name:MANION, MARTHANNE OLIVIA (MA LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARTHANNE
Middle Name:OLIVIA
Last Name:MANION
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 SAYRE AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2317
Mailing Address - Country:US
Mailing Address - Phone:859-269-1333
Mailing Address - Fax:859-259-1301
Practice Address - Street 1:637 SAYRE AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2317
Practice Address - Country:US
Practice Address - Phone:859-269-1333
Practice Address - Fax:859-259-1301
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY90103TC0700X
KYKY0418106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7573591OtherAETNA
KY000000331312OtherANTHEM BCBS