Provider Demographics
NPI:1235521253
Name:MANNING, MERRIDITH (LMFT)
Entity type:Individual
Prefix:
First Name:MERRIDITH
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 E ODYSSEY ST
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-5618
Mailing Address - Country:US
Mailing Address - Phone:208-576-9239
Mailing Address - Fax:
Practice Address - Street 1:6003 W OVERLAND RD STE 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-3075
Practice Address - Country:US
Practice Address - Phone:208-917-2543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6546101Y00000X, 106H00000X, 106H00000X
CA98777106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor