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General NPI Number Information
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NPI Number | 1356021133
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Entity Type | Organization
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Legal Business Name | MANIS FAMILY AND CHILD COUNSELING, A PROFESSIONAL CORP
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Dates
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Enumeration Date | 07/18/2023
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Last Update Date | 10/21/2023
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Provider Practice Location Address
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Address Line | 5431 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-1818
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Country | US
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Telephone | 951-529-9039
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 402339
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City | HESPERIA
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State | CA
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Zip | 92340-2339
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/ LMFT
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Name | MACIE TAYLOR MANIS
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Credential | LMFT
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Telephone | 951-529-9039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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