Most Relevant Information
Provider Data
| NPI Number: | 1003245564 |
| Provider Name: | KIMBERLY MANRIQUE M.S, L.P.C., A.T.R |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 950 |
Most Important Dates
| Enumeration Date: | 11/05/2013 |
| Last Updated: | 11/05/2013 |
Provider Practice Location
5798 DEER TRAIL DR
TRAVERSE CITY
MI
496848479
Practice Location Phone/Fax
| Phone: | 2317093177 |
| Fax: |
Provider Mailing Location
5798 DEER TRAIL DR
TRAVERSE CITY
MI
496848479
Provider Mailing Phone/Fax
| Phone: | 2317093177 |
| Fax: |