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General NPI Number Information
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NPI Number | 1417464967
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Entity Type | Individual
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Provider Name | SUSAN MICHELLE MANNOS LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 6591 SUTTON ST
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City | WESTMINSTER
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State | CA
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Zip | 92683-2116
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Country | US
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Telephone | 657-340-1005
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Fax |
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Provider Business Mailing Address
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Address Line | 25622 ADRIANA ST
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City | MISSION VIEJO
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State | CA
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Zip | 92691-3824
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Country | US
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Telephone | 949-338-1335
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF75648
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 300049AP
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT110222
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License Number State | CA
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