Provider Demographics
NPI:1952620072
Name:MANN, PETRA (LPC)
Entity type:Individual
Prefix:
First Name:PETRA
Middle Name:
Last Name:MANN
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 1:700 ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-3228
Mailing Address - Country:US
Mailing Address - Phone:832-276-2847
Mailing Address - Fax:512-392-1584
Practice Address - Street 1:700 ROGERS ST
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-3228
Practice Address - Country:US
Practice Address - Phone:832-276-2847
Practice Address - Fax:512-392-1584
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63646101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor