Basic Information
| Provider Information | |||||||||
| NPI: | 1154475127 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANANDIK | ||||||||
| FirstName: | DENISE | ||||||||
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| Credential: | M.S., LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 59 DAMONTE RANCH PKWY STE B451 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895211907 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 10038 MEADOW WAY UNIT D | ||||||||
| Address2: | |||||||||
| City: | TRUCKEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 961614974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304262110 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 08/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC46010 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | LMFT2626-R | NV | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.