Michelle L Mannia, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20042755A Issued in IN

Practice address

6640 Intech Blvd
Ste 195
Indianapolis, IN 46278-2011

Phone

(317) 295-0608

Fax

(317) 295-0622

NPI assigned

Nov 20, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Michelle L Leslie Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1353369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405555200000",
    "number": "1750625372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4507 EAGLE CREEK PKWY",
            "address_2": "UNIT 310",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462544374",
            "telephone_number": "574-276-9556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6640 INTECH BLVD",
            "address_2": "STE 195",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462782011",
            "telephone_number": "317-295-0608",
            "fax_number": "317-295-0622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANNIA",
        "first_name": "MICHELLE",
        "middle_name": "L",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-20",
        "last_updated": "2014-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39002420A",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20042755A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201228760",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "LESLIE",
            "middle_name": "L",
            "credential": "PSYD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Patrick Mann, M.D.
• Patrick L Mann, PA-C
• Todd Bradley Mann, DPM
• Manish Mannan, MD
• Manni Care LLC
• April Manning
• Astra Manning, RN
• Lindsay Manning, NP
• Sara Manning, MD
• Temeka Manning

• Clinical Psychologist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.