Provider Demographics
NPI:1700872124
Name:MANNING, BILLY D (PHD)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:D
Last Name:MANNING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-3603
Mailing Address - Country:US
Mailing Address - Phone:620-371-7900
Mailing Address - Fax:
Practice Address - Street 1:1715 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-3603
Practice Address - Country:US
Practice Address - Phone:620-371-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCPC012101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS012OtherLCPC
KS119036OtherMEDICARE
KS7586839901Medicaid
KS7586839901Medicaid
KS119036OtherMEDICARE