Healthcare Provider Details

I. General information

NPI: 1023972791
Provider Name (Legal Business Name): MANIFEST MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 MARIE LN
NORTH MANKATO MN
56003-3412
US

IV. Provider business mailing address

1824 MARIE LN
NORTH MANKATO MN
56003-3412
US

V. Phone/Fax

Practice location:
  • Phone: 507-399-1855
  • Fax: 507-399-1855
Mailing address:
  • Phone: 507-399-1855
  • Fax: 507-399-1855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. SARA MICHELLE MENNEN
Title or Position: OWNER/LMFT
Credential: MS, LMFT
Phone: 507-399-1855