Provider Demographics
NPI:1669578399
Name:MANILLA, PHILIP (LPCC)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:MANILLA
Suffix:
Gender:M
Credentials:LPCC
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 790
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0790
Mailing Address - Country:US
Mailing Address - Phone:606-329-8588
Mailing Address - Fax:606-329-8195
Practice Address - Street 1:3701 LANDSDOWNE DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-5422
Practice Address - Country:US
Practice Address - Phone:606-324-3005
Practice Address - Fax:606-329-1530
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY102962101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000286533OtherANTHEM BCBS
11738942OtherCAQH
000516911OtherUNITED BEHAVIORAL HEALTH
APPROVEDOtherCIGNA
KY710281010Medicaid
610661987OtherLIFESYNCH