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General NPI Number Information
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NPI Number | 1306312657
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Entity Type | Individual
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Provider Name | KANDI MANLEY LCPC
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Gender | Female
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Dates
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Enumeration Date | 10/14/2018
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 2590 S 2000 W STE 4
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City | REXBURG
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State | ID
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Zip | 83440-4028
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Country | US
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Telephone | 208-948-3423
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Fax |
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Provider Business Mailing Address
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Address Line | 2590 S 2000 W STE 4
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City | REXBURG
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State | ID
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Zip | 83440-4028
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Country | US
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Telephone | 208-948-3423
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC-7239
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License Number State | ID
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