Healthcare Provider Details

I. General information

NPI: 1376295543
Provider Name (Legal Business Name): ANGEL MANJARREZ PH.D., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S CRAWFORD RD APT H30
MOUNT PLEASANT MI
48858-9360
US

IV. Provider business mailing address

2222 S CRAWFORD RD APT H30
MOUNT PLEASANT MI
48858-9360
US

V. Phone/Fax

Practice location:
  • Phone: 952-797-2626
  • Fax:
Mailing address:
  • Phone: 952-797-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0020146
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: