Provider Demographics
NPI:1053552588
Name:MCMANUS, LISA (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:AL
Mailing Address - Zip Code:36559-0062
Mailing Address - Country:US
Mailing Address - Phone:251-202-5655
Mailing Address - Fax:251-202-5707
Practice Address - Street 1:27625 US HIGHWAY 98
Practice Address - Street 2:BLDG. A
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4816
Practice Address - Country:US
Practice Address - Phone:251-626-7959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1506101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51593781OtherBLUE CROSS BLUE SHIELD OF AL