Individual ProviderEric Leland MangumCounselorBehavioral Health & Social Service ProvidersPractice Address1601 E 4th Blvd., Vancouver, WA 98661(360) 397-8246(360) 831-3054PECOS EnrollmentBased on the most recent information from CMS, provider Eric Leland Mangum does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 10:04 AM.Profile DetailsProvider ID1952950222Provider TypeIndividualFull NameMangum, Eric LelandGenderMaleSole ProprietorNoEnumeration Date9/9/2019Last Updated11/5/2024Contact InformationPractice LocationPractice Address1601 E 4th Blvd., Vancouver, WA 98661Phone(360) 397-8246FaxUnlisted FaxMailing LocationMailing Address1221 SE Ellsworth Rd Apt V246, Vancouver, WA 98664-6234Phone(360) 831-3054FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseMC61349637WashingtonCode101YA0400XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer