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General NPI Number Information
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NPI Number | 1639711641
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Entity Type | Individual
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Provider Name | MEGAN JEAN MANTY MS, LPCC
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Gender | Female
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Dates
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Enumeration Date | 10/10/2019
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 12400 PORTLAND AVE STE 130
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City | BURNSVILLE
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State | MN
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Zip | 55337-6839
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Country | US
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Telephone | 763-607-7817
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Fax | 612-662-8779
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Provider Business Mailing Address
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Address Line | 12400 PORTLAND AVE STE 130
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City | BURNSVILLE
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State | MN
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Zip | 55337-6839
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Country | US
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Telephone | 763-607-7817
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Fax | 612-662-8779
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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 | 2260
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 02260
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License Number State | MN
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