Jackie Manivanh, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

69071 Issued in TX

Practice address

4516 Boat Club Rd Ste 106
Fort Worth, TX 76135-7020

Phone

(817) 238-0106

NPI assigned

Jul 15, 2016

Last updated

Jul 15, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mptx.jackie.manivanh@149977.advancedmd-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mark David Levine, MD Psychiatrists Professional Corporation

  dba Mindpath Health

  • Psychiatry Physician
  • Frisco, TX
  • NPI 1841626447

  Professional

  Medicare reassignment NPD
• Mindpath Health Texas PLLC

  • Psychiatry Physician
  • Frisco, TX
  • NPI 1073482105

  Professional

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468540800000",
    "number": "1225481146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4516 BOAT CLUB RD STE 106",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761357020",
            "telephone_number": "817-238-0106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4516 BOAT CLUB RD STE 106",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761357020",
            "telephone_number": "817-238-0106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANIVANH",
        "first_name": "JACKIE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-15",
        "last_updated": "2016-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "69071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shea Maness, MA, BCBA
• Belinda Chandara Hong Mang, PHARM.D.
• Michael T Mangan
• Tia Manierre, LCSW
• Dianna Ingabire Manigabe, RN
• Sarah Manjee
• Jasmin Akber Manji
• Prema Manjunath, MD
• Basem Mankerious, PT, DPT
• Moody Mankerious, DPM

• Professional Counselor in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.