=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184845455
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA ANN MUSSELMAN L.L.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 80 68TH ST SE SUITE 300
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49548-6980
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-292-1995
-----------------------------------------------------
Fax | 616-827-2277
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 519
-----------------------------------------------------
City | BYRON CENTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49315-0519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-292-1995
-----------------------------------------------------
Fax | 616-827-2277
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 6301009957
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------