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NPI Code Detail

MEDICARE: PROF. MICHAEL ANTHONY ANGELO LCPC

MEDICARE: PROF. MICHAEL ANTHONY ANGELO LCPC
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
1101YM0800XMental Health Counselor180.009518IL
2101YM0800XMental Health Counselor6401018853MI

General Provider Information

NPI Number : 1154668515
Entity Type Code : Individual
Provider Name (Legal Business Name) : PROF. MICHAEL ANTHONY ANGELO LCPC
Provider Business Mailing Address
First Line : 6430 OLD HUNTERS RUN
Second Line :
City : ROCKFORD
State : IL
Zip : 61114-7812
Country : US
Telephone Number : 331-575-5035
Fax Number :
Provider Business Practice Location Address
First Line : 250 MONROE AVE NW STE 400
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2293
Country : US
Telephone Number : 331-575-5035
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2013
Last Update Date : 05/07/2026

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