MEDICARE: MENTAL MANNA COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1750238051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTAL MANNA COUNSELING PLLC

Provider Business Mailing Address
First Line	:	41318 W ALMIRA DR
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138-4492
Country	:	US
Telephone Number	:	919-491-2455
Fax Number	:

Provider Business Practice Location Address
First Line	:	41318 W ALMIRA DR
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138-4492
Country	:	US
Telephone Number	:	919-491-2455
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ANDRE DEZAN GREEN JR.
Credential	:	LPC
Telephone Number	:	919-491-2455

Provider Enumeration Date	:	03/14/2026
Last Update Date	:	03/14/2026

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