Basic Information
| Provider Information | |||||||||
| NPI: | 1851413280 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANA-AY | ||||||||
| FirstName: | BENITA | ||||||||
| MiddleName: | SABINA FLORES | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.ED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12515 MERIDIAN E | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983733436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538482805 | ||||||||
| FaxNumber: | 2534355980 | ||||||||
| Practice Location | |||||||||
| Address1: | 12515 MERIDIAN E | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983733436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538482805 | ||||||||
| FaxNumber: | 2534355980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LH00006461 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.