| Krystal Lynn Manning, | |
|
1620 S Kimball Ave, Caldwell, ID 83605-4547 | |
| (208) 505-2950 | |
| (208) 505-2955 |
| Full Name | Krystal Lynn Manning |
|---|---|
| Gender | Female |
| Speciality | Marriage & Family Therapist |
| Location | 1620 S Kimball Ave, Caldwell, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508575184 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 146126 (California) | Secondary |
| 106H00000X | Marriage & Family Therapist | 2061075 (Idaho) | Primary |
| Entity Name | St Lukes Clinic-treasure Valley Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1326336058 PECOS PAC ID: 4981878402 Enrollment ID: O20111119000045 |
| Mailing Address | Practice Location Address |
|---|---|
| Krystal Lynn Manning, 190 E Bannock St, Boise, ID 83712-6241 Ph: () - | Krystal Lynn Manning, 1620 S Kimball Ave, Caldwell, ID 83605-4547 Ph: (208) 505-2950 |
Crystal Johnson, Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 2903 Dale Ln, Caldwell, ID 83605 Phone: 530-712-6127 | |
Mr. Allan Lee West, LMFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 215 S 11th Ave, Caldwell, ID 83605 Phone: 208-454-8107 | |
Estella Acosta, LMFT Couples Therapy Medicare: Not Enrolled in Medicare Practice Location: 524 Cleveland Blvd, Caldwell, ID 83605 Phone: 208-514-6886 |