Provider Demographics
NPI:1487763397
Name:MANCHON, JANET RAE (MS, NCC)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:RAE
Last Name:MANCHON
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 BAYOU CIR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-4669
Mailing Address - Country:US
Mailing Address - Phone:850-835-4848
Mailing Address - Fax:
Practice Address - Street 1:280 BAYOU CIR
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:FL
Practice Address - Zip Code:32439-4669
Practice Address - Country:US
Practice Address - Phone:850-835-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health