MEDICARE: MS. CLAIRE PRESLEY ANGLE LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFT000927	GA

General Provider Information

NPI Number	:	1003459819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CLAIRE PRESLEY ANGLE LMFT

Provider Business Mailing Address
First Line	:	1371 ORCHARD HILL RD
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-2551
Country	:	US
Telephone Number	:	478-320-8158
Fax Number	:	478-445-6062

Provider Business Practice Location Address
First Line	:	1371 ORCHARD HILL RD
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-2551
Country	:	US
Telephone Number	:	478-320-8158
Fax Number	:	478-445-6062

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2019
Last Update Date	:	10/24/2019

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