Provider Demographics
NPI:1831232180
Name:MICHAEL MCMANUS ASSOCIATES PA
Entity type:Organization
Organization Name:MICHAEL MCMANUS ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-830-8340
Mailing Address - Street 1:PO BOX 2418
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-2418
Mailing Address - Country:US
Mailing Address - Phone:850-830-8340
Mailing Address - Fax:850-837-0123
Practice Address - Street 1:4507 FURLING LN
Practice Address - Street 2:SUITE 212
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5328
Practice Address - Country:US
Practice Address - Phone:850-830-8340
Practice Address - Fax:850-837-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW1774101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty