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NPI Code Detail

MEDICARE: ELLEN ELIZABETH MANER

MEDICARE: ELLEN ELIZABETH MANER
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
1101YM0800XMental Health Counselor
2101YA0400XAddiction (Substance Use Disorder) Counselor1536TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770724387
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN ELIZABETH MANER
Provider Business Mailing Address
First Line : 200 TECH CENTER DR
Second Line :
City : KNOXVILLE
State : TN
Zip : 37912-2747
Country : US
Telephone Number : 865-637-9711
Fax Number :
Provider Business Practice Location Address
First Line : 200 TECH CENTER DR
Second Line :
City : KNOXVILLE
State : TN
Zip : 37912-2747
Country : US
Telephone Number : 865-637-9711
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2009
Last Update Date : 03/11/2024

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