Provider Demographics
NPI:1134519648
Name:MANUS, THOMAS EMORY (ACB0007317)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:EMORY
Last Name:MANUS
Suffix:
Gender:M
Credentials:ACB0007317
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5160 N UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-2033
Mailing Address - Country:US
Mailing Address - Phone:719-550-1011
Mailing Address - Fax:719-550-1531
Practice Address - Street 1:5160 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2033
Practice Address - Country:US
Practice Address - Phone:719-550-1011
Practice Address - Fax:719-550-1531
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB0007317101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)