MEDICARE: ANGELA MOSS BURNS

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	7095	CA
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor	16830	CA

General Provider Information

NPI Number	:	1558904136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MOSS BURNS

Provider Business Mailing Address
First Line	:	PO BOX 507
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-0507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3960 INDUSTRIAL BLVD # 600
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-3496
Country	:	US
Telephone Number	:	951-440-5016
Fax Number	:

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

Provider Enumeration Date	:	10/25/2019
Last Update Date	:	09/06/2024

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