Healthcare Provider Details

I. General information

NPI: 1700615028
Provider Name (Legal Business Name): LAUREN KAY MANION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 W ELLIOT RD
GILBERT AZ
85233-5129
US

IV. Provider business mailing address

16239 W MORELAND ST
GOODYEAR AZ
85338-2736
US

V. Phone/Fax

Practice location:
  • Phone: 480-818-6777
  • Fax:
Mailing address:
  • Phone: 623-224-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: