Healthcare Provider Details

I. General information

NPI: 1619082195
Provider Name (Legal Business Name): TODD E ANGLEBRANDT BS, CAC-II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 IMLAY CITY RD
LAPEER MI
48446-3208
US

IV. Provider business mailing address

3117 W OREGON RD
LAPEER MI
48446-7701
US

V. Phone/Fax

Practice location:
  • Phone: 810-245-5689
  • Fax: 810-245-5676
Mailing address:
  • Phone: 810-334-8165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2-00816
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: