MEDICARE: ANGELA MARIE BAAN EDDY

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	6401014928	MI

General Provider Information

NPI Number	:	1326406778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIE BAAN EDDY

Provider Business Mailing Address
First Line	:	2362 LASSITER DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1519
Country	:	US
Telephone Number	:	248-923-1971
Fax Number	:

Provider Business Practice Location Address
First Line	:	2362 LASSITER DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1519
Country	:	US
Telephone Number	:	947-517-4012
Fax Number	:

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

Provider Enumeration Date	:	01/31/2016
Last Update Date	:	04/16/2021

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