Provider Demographics
NPI:1538757620
Name:MANLY, NANCY JO (LPC)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JO
Last Name:MANLY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 COLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-4011
Mailing Address - Country:US
Mailing Address - Phone:719-237-2102
Mailing Address - Fax:
Practice Address - Street 1:2185 COLDSTONE WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-4011
Practice Address - Country:US
Practice Address - Phone:719-237-2102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC00005100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLPC0005100OtherLICENSE