Basic Information
| Provider Information | |||||||||
| NPI: | 1831512060 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCMANUS | ||||||||
| FirstName: | REBECCA | ||||||||
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| OtherLastName: | MCMANUS | ||||||||
| OtherFirstName: | BECKY | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1012 HIDDEN CREEK DRIVE NE | ||||||||
| Address2: | APT. 201 | ||||||||
| City: | KEIZER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037545469 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2645 PORTLAND RD. NE | ||||||||
| Address2: | #120 | ||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033905637 | ||||||||
| FaxNumber: | 5033933135 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2014 | ||||||||
| LastUpdateDate: | 06/28/2016 | ||||||||
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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 | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.