Provider Demographics
NPI:1962203497
Name:MANZANO BILLMAN, ELISHA DANIEL
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:DANIEL
Last Name:MANZANO BILLMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ELISHA
Other - Middle Name:DANIEL
Other - Last Name:BILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37875 JASPER LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:OR
Mailing Address - Zip Code:97438-9751
Mailing Address - Country:US
Mailing Address - Phone:541-971-0600
Mailing Address - Fax:
Practice Address - Street 1:37875 JASPER LOWELL RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:OR
Practice Address - Zip Code:97438-9751
Practice Address - Country:US
Practice Address - Phone:541-971-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health