Basic Information
| Provider Information | |||||||||
| NPI: | 1710952221 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MANJARRES AND ASSOCIATES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 N GREENLEAF ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | GURNEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600313393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473608860 | ||||||||
| FaxNumber: | 8473608864 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 N GREENLEAF ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GURNEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600313393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473608860 | ||||||||
| FaxNumber: | 8473608864 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2006 | ||||||||
| LastUpdateDate: | 09/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | MANJARRES | ||||||||
| AuthorizedOfficialFirstName: | RODRIGO | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8473608860 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LCPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 180002842 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.