Healthcare Provider Details

I. General information

NPI: 1023765070
Provider Name (Legal Business Name): ANGELA M SCOGGIN LMFT, MAPSY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E DEWEY ST STE 209
BUCHANAN MI
49107-1494
US

IV. Provider business mailing address

16498 S RED BUD TRL
BUCHANAN MI
49107-9466
US

V. Phone/Fax

Practice location:
  • Phone: 269-340-0071
  • Fax:
Mailing address:
  • Phone: 269-362-5762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101007713
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: