Healthcare Provider Details

I. General information

NPI: 1215779913
Provider Name (Legal Business Name): STACY JEAN MANETH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACY WHITELEY/POE

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 HOLLY LN
SALINA KS
67401-8452
US

IV. Provider business mailing address

730 HOLLY LN
SALINA KS
67401-8452
US

V. Phone/Fax

Practice location:
  • Phone: 785-452-4930
  • Fax: 785-452-4932
Mailing address:
  • Phone: 785-452-4930
  • Fax: 785-452-4932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC04668
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLPC04668
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: