MEDICARE: MS. LASHON MICHELLE MANNING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1548553621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LASHON MICHELLE MANNING

Provider Business Mailing Address
First Line	:	1872 W LA SIERRA DR
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93706-2417
Country	:	US
Telephone Number	:	559-445-0214
Fax Number	:

Provider Business Practice Location Address
First Line	:	2772 MLK BLVD
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93706-0000
Country	:	US
Telephone Number	:	559-265-4800
Fax Number	:	559-265-4823

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2011
Last Update Date	:	05/23/2011

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