Provider Demographics
NPI:1700127719
Name:MANLEY COUNSELING AND CONSULTING PLLC
Entity Type:Organization
Organization Name:MANLEY COUNSELING AND CONSULTING PLLC
Other - Org Name:MANLEY COUNSELING AND CONSULTING PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DON
Authorized Official - Last Name:MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:615-278-0347
Mailing Address - Street 1:621 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-1619
Mailing Address - Country:US
Mailing Address - Phone:615-278-0347
Mailing Address - Fax:
Practice Address - Street 1:621 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1619
Practice Address - Country:US
Practice Address - Phone:615-278-0347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1949101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty