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General NPI Number Information
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NPI Number | 1497071534
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Entity Type | Individual
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Provider Name | JERI LYNNE MANHAL M.A., L.P.C., N.C.C.
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Gender | Female
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Dates
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Enumeration Date | 04/14/2010
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Last Update Date | 04/14/2010
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Provider Practice Location Address
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Address Line | 1618 WILLIAMS DR. SUITE 4
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City | GEORGETOWN
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State | TX
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Zip | 78628
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Country | US
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Telephone | 512-415-5549
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Fax |
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Provider Business Mailing Address
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Address Line | 1618 WILLIAMS DR. SUITE 4
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City | GEORGETOWN
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State | TX
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Zip | 78628
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Country | US
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Telephone | 512-415-5549
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 215708
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 62113
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License Number State | TX
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