Individual
MR. GEORGE MICHAEL MANTAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.L.P.
Contact information
Practice address
1001 MILITARY ST, PORT HURON, MI 48060-5416
(810) 985-5168
(810) 985-9011
Mailing address
5360 SMITHS CREEK RD, KIMBALL, MI 48074-3807
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
6301010808
MI
103TC0700X
Clinical Psychologist
Primary
6301010808
MI
Other
Enumeration date
09/06/2006
Last updated
09/11/2008
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