Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 950 | NH |
Y | 101YP2500X | Professional Counselor | 6401013605 | MI |
NPI | 1003245564 |
---|---|
Provider Name | Kimberly Manrique |
First Address | Traverse City, MI 49684-8479 |
Second Address | Traverse City, MI 49684-8479 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2013 |
Last Update Date | 05/11/2013 |