Provider Demographics
NPI:1306312657
Name:MANLEY, KANDI (LCPC)
Entity type:Individual
Prefix:
First Name:KANDI
Middle Name:
Last Name:MANLEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 S 2000 W STE 4
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-4028
Mailing Address - Country:US
Mailing Address - Phone:208-948-3423
Mailing Address - Fax:
Practice Address - Street 1:2590 S 2000 W STE 4
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-4028
Practice Address - Country:US
Practice Address - Phone:208-948-3423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-14
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-7239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional