Active NPI
Jeanie Manson, LISAC
- Addiction (Substance Use Disorder) Counselor
- Page, AZ
National Provider Identifier
1902237191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- LISAC-10431
- Practice address
- 337 N. Navajo Drive
Page, AZ 86040 - Phone
- (928) 645-6840
- Fax
- (928) 645-8158
- NPI assigned
- Dec 12, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LISAC-10431 | AZ | Primary |
Addresses
Primary practice location
337 N. Navajo Drive
Page, AZ 86040
Mailing address
PO Box 4466
Page, AZ 86040
Phone (928) 645-6840
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LISAC-10431 | AZ | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386806400000",
"number": "1902237191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4466",
"city": "PAGE",
"state": "AZ",
"postal_code": "86040",
"telephone_number": "928-645-6840",
"fax_number": "928-645-8158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "337 N. NAVAJO DRIVE",
"city": "PAGE",
"state": "AZ",
"postal_code": "86040",
"telephone_number": "928-645-6840",
"fax_number": "928-645-8158"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANSON",
"first_name": "JEANIE",
"name_prefix": "Mrs.",
"credential": "LISAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-12-12",
"last_updated": "2013-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "AZ",
"license": "LISAC-10431",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Page, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.