Individual
TRACEY DENISE MANIGAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA., CSP
Contact information
Practice address
8900 N CENTRAL AVE STE 108F, PHOENIX, AZ 85020-2869
(928) 206-1766
Mailing address
9224 N 2ND AVE, PHOENIX, AZ 85021-3504
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
4241632
AZ
103TS0200X
School Psychologist
Primary
4241632
AZ
106S00000X
Behavior Technician
—
—
171400000X
Health & Wellness Coach
—
—
171M00000X
Case Manager/Care Coordinator
—
—
251S00000X
Community/Behavioral Health Agency
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
374700000X
Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4241632
CERTIFIED SCHOOL PSYCHOLOGIST
AZ
Enumeration date
05/17/2017
Last updated
07/27/2024
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