MEDICARE: JANELLE A. MANNING PSYD

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		CA
2	103TC0700X	Clinical Psychologist	PSY27507	CA

General Provider Information

NPI Number	:	1942634324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANELLE A. MANNING PSYD

Provider Business Mailing Address
First Line	:	3443 W SHAW AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3249
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 W SHAW AVE
Second Line	:	SUITE 203
City	:	FRESNO
State	:	CA
Zip	:	93711-3713
Country	:	US
Telephone Number	:	559-449-2730
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	08/31/2015

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