Provider Demographics
NPI:1972778686
Name:OCCHIOGROSSO, MANUEL (LMHC)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:OCCHIOGROSSO
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7348 BALTRAY PL SW
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-7691
Mailing Address - Country:US
Mailing Address - Phone:360-360-0334
Mailing Address - Fax:360-598-0039
Practice Address - Street 1:3309 56TH ST STE 101
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8580
Practice Address - Country:US
Practice Address - Phone:360-360-0334
Practice Address - Fax:360-443-2365
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8662101YA0400X, 101YA0400X
216170101YP2500X
FLMH 8662101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional