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General NPI Number Information
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NPI Number | 1639431497
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Entity Type | Individual
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Provider Name | MICHAEL DOMINICK DEANGELIS LPC-MHSP
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Gender | Male
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 600 S ROSEWOOD DR
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City | CLARKSVILLE
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State | TN
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Zip | 37043-5268
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Country | US
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Telephone | 931-218-6100
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Fax | 931-477-2377
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Provider Business Mailing Address
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Address Line | 600 S ROSEWOOD DR
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City | CLARKSVILLE
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State | TN
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Zip | 37043-5268
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Country | US
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Telephone | 931-218-6100
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Fax | 931-477-2377
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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 | 4827
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License Number State | TN
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