Provider Demographics
NPI:1831320407
Name:MANEES, ANNE MARIE (PSYD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:MANEES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W 103RD ST STE 280
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1109
Mailing Address - Country:US
Mailing Address - Phone:317-574-1785
Mailing Address - Fax:
Practice Address - Street 1:201 W 103RD ST STE 280
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1109
Practice Address - Country:US
Practice Address - Phone:317-574-1785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042325A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical