MEDICARE: ANGEL RENEE BIRCH LPCC

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	101YP2500X	Professional Counselor	297557	KY

General Provider Information

NPI Number	:	1124826003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL RENEE BIRCH LPCC

Provider Business Mailing Address
First Line	:	200 MULBERRY ST STE A
Second Line	:
City	:	BOONEVILLE
State	:	KY
Zip	:	41314-7505
Country	:	US
Telephone Number	:	606-593-6023
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MULBERRY ST STE A
Second Line	:
City	:	BOONEVILLE
State	:	KY
Zip	:	41314-7505
Country	:	US
Telephone Number	:	606-593-6023
Fax Number	:

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

Provider Enumeration Date	:	03/05/2025
Last Update Date	:	03/05/2025

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