Healthcare Provider Details

I. General information

NPI: 1497824940
Provider Name (Legal Business Name): MARIE ELIZABETH MANION MA, PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13160 COUNTY RD. 3610
ST. JAMES MO
65559
US

IV. Provider business mailing address

1900 WHITE COLUMNS DR APT. B
ROLLA MO
65401-2042
US

V. Phone/Fax

Practice location:
  • Phone: 573-265-3251
  • Fax:
Mailing address:
  • Phone: 573-368-0106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2006025674
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: