Provider Demographics
NPI:1376295543
Name:MANJARREZ, ANGEL (LPC)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:MANJARREZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 S COLORADO BLVD STE C304
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3345
Mailing Address - Country:US
Mailing Address - Phone:952-797-2626
Mailing Address - Fax:
Practice Address - Street 1:1355 S COLORADO BLVD STE C304
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3345
Practice Address - Country:US
Practice Address - Phone:952-797-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020146101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty