Doctor Name: | DR. MATTHEW BLAKE MANIS |
NPI Number: | 1215360490 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD., BA., CLC |
License Number: | |
Business Practice Address: | 1601 Hwy 77 N. Waxahachie, TX - 75165 |
Business Phone Number: | 2142301621 |
Business Fax Number: | 9729350930 |
Mailing Address: | 119 Chesterfield Cir, WAXAHACHIE |
State: | TX |
Postal Code: | 751656362 |
Phone Number: | 2142301621 |
Fax Number: | 9729350930 |
NPI Enumeration Date: | 08/12/2013 |
NPI Last Update Date: | 08/12/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |