MEDICARE: MS. ELIZABETH MARIA ANGULO CDP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CP60018150	WA

General Provider Information

NPI Number	:	1497982821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH MARIA ANGULO CDP

Provider Business Mailing Address
First Line	:	2009 NE 117TH ST STE 101
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98686-4022
Country	:	US
Telephone Number	:	360-566-9112
Fax Number	:	360-566-9133

Provider Business Practice Location Address
First Line	:	2009 NE 117TH ST STE 101
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98686-4022
Country	:	US
Telephone Number	:	360-566-9112
Fax Number	:	360-566-9133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2009
Last Update Date	:	06/27/2019

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