Provider Demographics
NPI:1023763984
Name:MANGUS, PATRICIA L (LPCC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:MANGUS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:L
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12402 CARTWAY ST NE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-9412
Mailing Address - Country:US
Mailing Address - Phone:330-614-8706
Mailing Address - Fax:
Practice Address - Street 1:12402 CARTWAY ST NE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-9412
Practice Address - Country:US
Practice Address - Phone:330-614-8706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2404150101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty