Individual
MR. MANNY ATHANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
483 W. SEED FARM RD., SACATON, AZ 85147
(602) 528-1200
(602) 528-1374
Mailing address
PO BOX 38, SACATON, AZ 85147
(602) 528-1200
(602) 528-1374
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
10524
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10524
BH LICENSE
AZ
Enumeration date
02/17/2016
Last updated
02/17/2016
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