| Doctor Name: | KIMBERLY MANRIQUE |
| NPI Number: | 1003245564 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S, L.P.C., A.T.R |
| License Number: | 950 |
| Business Practice Address: | 5798 Deer Trail Dr Traverse City, MI - 496848479 |
| Business Phone Number: | 2317093177 |
| Business Fax Number: | |
| Mailing Address: | 5798 Deer Trail Dr, TRAVERSE CITY |
| State: | MI |
| Postal Code: | 496848479 |
| Phone Number: | 2317093177 |
| Fax Number: | |
| NPI Enumeration Date: | 11/05/2013 |
| NPI Last Update Date: | 11/05/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 950 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |