MEDICARE: ANGELA BRAGGS LPC-IT

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	101YM0800X	Mental Health Counselor	4575-226	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427681550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA BRAGGS LPC-IT

Provider Business Mailing Address
First Line	:	11002 W PARK PL
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-3615
Country	:	US
Telephone Number	:	414-949-0758
Fax Number	:

Provider Business Practice Location Address
First Line	:	11002 W PARK PL
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-3615
Country	:	US
Telephone Number	:	414-949-0758
Fax Number	:

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

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	02/17/2020

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Directions to “ ANGELA BRAGGS LPC-IT” Practice Location

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