Provider Demographics
NPI:1932909157
Name:FLOYD, MANESSHA TENEAL
Entity type:Individual
Prefix:
First Name:MANESSHA
Middle Name:TENEAL
Last Name:FLOYD
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 1:10891 LEXINGTON DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-9302
Mailing Address - Country:US
Mailing Address - Phone:901-351-3827
Mailing Address - Fax:
Practice Address - Street 1:6952 DOGWOOD MNR N STE 103
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-2091
Practice Address - Country:US
Practice Address - Phone:662-874-6921
Practice Address - Fax:662-932-2921
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-1306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty