Provider Demographics
NPI:1881773083
Name:MANTON, KRISTA MARIE-MEREZKO (LPC)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:MARIE-MEREZKO
Last Name:MANTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 N 3RD ST
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2544
Mailing Address - Country:US
Mailing Address - Phone:307-742-4769
Mailing Address - Fax:307-742-6702
Practice Address - Street 1:1050 N 3RD ST
Practice Address - Street 2:SUITE B-1
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2544
Practice Address - Country:US
Practice Address - Phone:307-742-4769
Practice Address - Fax:307-742-6702
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC894101YP2500X
WYLPC #894101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor