Individual
MICHELLE L MANNIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
6640 INTECH BLVD, STE 195, INDIANAPOLIS, IN 46278-2011
(317) 295-0608
(317) 295-0622
Mailing address
4507 EAGLE CREEK PKWY, UNIT 310, INDIANAPOLIS, IN 46254-4374
(574) 276-9556
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
39002420A
IN
103TC0700X
Clinical Psychologist
Primary
20042755A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201228760
—
IN
Enumeration date
11/20/2012
Last updated
07/17/2014
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