=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174217814
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA DENISE WEBERG-DAVIS LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2023
-----------------------------------------------------
Last Update Date | 01/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1611 OAK AVE
-----------------------------------------------------
City | MUSKEGON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49442-2468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-767-1921
-----------------------------------------------------
Fax | 231-767-0527
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1284 RANSOM ST
-----------------------------------------------------
City | MUSKEGON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49442-3328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-672-0688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6451022960
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------