MEDICARE: TERESA VISOSO-RANGEL MA

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	101Y00000X	Counselor	6401013572	MI

General Provider Information

NPI Number	:	1295168177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA VISOSO-RANGEL MA

Provider Business Mailing Address
First Line	:	2685 STEAMBOAT SPRINGS DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1364
Country	:	US
Telephone Number	:	248-425-6470
Fax Number	:

Provider Business Practice Location Address
First Line	:	2685 STEAMBOAT SPRINGS DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1364
Country	:	US
Telephone Number	:	248-425-6470
Fax Number	:

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

Provider Enumeration Date	:	08/15/2013
Last Update Date	:	08/15/2013

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