Healthcare Provider Details

I. General information

NPI: 1639711641
Provider Name (Legal Business Name): MEGAN JEAN MANTY MS, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 XERXES AVE S STE 110
BLOOMINGTON MN
55431-1200
US

IV. Provider business mailing address

7901 XERXES AVE S STE 110
BLOOMINGTON MN
55431-1200
US

V. Phone/Fax

Practice location:
  • Phone: 763-607-7817
  • Fax: 612-662-8779
Mailing address:
  • Phone: 763-607-7817
  • Fax: 612-662-8779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2260
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number02260
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: