Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 102L00000X | Psychologist | 5813621 | AZ |
N | 103T00000X | Psychologist | 5813621 | AZ |
N | 106S00000X | Behavior Technician |
NPI | 1154926913 |
---|---|
Provider Name | Dr. Ronnie Manns |
First Address | Maricopa, AZ 85139-9121 |
Second Address | Maricopa, AZ 85139-9121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2020 |
Last Update Date | 22/09/2021 |