Healthcare Provider Details

I. General information

NPI: 1285273102
Provider Name (Legal Business Name): ANGELICA ROSE CANALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELICA ROSE MORALES

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 3 MILE RD NW STE 200
GRAND RAPIDS MI
49544-1691
US

IV. Provider business mailing address

7108 S KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: