Provider Demographics
NPI:1699943779
Name:MANUSOS, JUDITH A (LPC)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:MANUSOS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 NORTHSIDE DR NE STE 5
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2355
Mailing Address - Country:US
Mailing Address - Phone:320-762-8551
Mailing Address - Fax:320-762-8550
Practice Address - Street 1:460 NORTHSIDE DR NE STE 5
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2355
Practice Address - Country:US
Practice Address - Phone:320-762-8551
Practice Address - Fax:320-762-8550
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00204101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional