Provider Demographics
NPI:1558630228
Name:MANIGAULT, JAMYE LYNN
Entity type:Individual
Prefix:
First Name:JAMYE
Middle Name:LYNN
Last Name:MANIGAULT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 HUNTER LAKE WAY
Mailing Address - Street 2:APT # 205
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-8190
Mailing Address - Country:US
Mailing Address - Phone:407-733-0094
Mailing Address - Fax:
Practice Address - Street 1:958 VINERDIGE RUN
Practice Address - Street 2:# 206
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-1763
Practice Address - Country:US
Practice Address - Phone:407-733-0094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist