Healthcare Provider Details

I. General information

NPI: 1023070232
Provider Name (Legal Business Name): ANGELA M SCOTT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 LEONARD ST NE
GRAND RAPIDS MI
49505-5650
US

IV. Provider business mailing address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

V. Phone/Fax

Practice location:
  • Phone: 616-956-9619
  • Fax: 616-956-8033
Mailing address:
  • Phone: 616-455-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401007626
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: