=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699350124
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPHINE H MANTON LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2021
-----------------------------------------------------
Last Update Date | 03/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7922 WRENWOOD BLVD STE A
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70809-1785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-505-7366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5445 POINT CLAIR RD UNIT 145
-----------------------------------------------------
City | CARVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70721-2120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-505-7366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 5710
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------