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General NPI Number Information
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NPI Number | 1710952221
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Entity Type | Organization
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Legal Business Name | MANJARRES AND ASSOCIATES, INC
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Dates
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Enumeration Date | 02/18/2006
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Last Update Date | 09/20/2019
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Provider Practice Location Address
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Address Line | 135 N GREENLEAF ST SUITE 201
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City | GURNEE
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State | IL
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Zip | 60031-3393
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Country | US
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Telephone | 847-360-8860
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Fax | 847-360-8864
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Provider Business Mailing Address
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Address Line | 135 N GREENLEAF ST SUITE 2
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City | GURNEE
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State | IL
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Zip | 60031-3393
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Country | US
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Telephone | 847-360-8860
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Fax | 847-360-8864
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. RODRIGO A MANJARRES
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Credential | LCPC
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Telephone | 847-360-8860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180002842
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License Number State | IL
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