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General NPI Number Information
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NPI Number | 1477908465
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Entity Type | Individual
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Provider Name | ANGELA MARIE TAYSON MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 1056 ALPINE DR
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City | GREEN BAY
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State | WI
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Zip | 54311-5400
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Country | US
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Telephone | 231-420-6707
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Fax | --
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Provider Business Mailing Address
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Address Line | 1056 ALPINE DR
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City | GREEN BAY
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State | WI
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Zip | 54311-5400
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Country | US
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Telephone | 231-420-6707
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Fax | --
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PPC-1114
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-2028
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10336-125
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License Number State | WI
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