Provider Demographics
NPI:1457406449
Name:MCMANUS, MARY PAMELA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:PAMELA
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:W
Other - Last Name:MCMANUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77342-0191
Mailing Address - Country:US
Mailing Address - Phone:936-291-7928
Mailing Address - Fax:938-294-0164
Practice Address - Street 1:1325 WINDSOR ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5615
Practice Address - Country:US
Practice Address - Phone:936-291-7928
Practice Address - Fax:936-294-0164
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25054103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1705261-01Medicaid
TX1705261-01Medicaid