MEDICARE: CHRISTINA NICOLE MANGOLD

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	6801120412	MI

General Provider Information

NPI Number	:	1669127700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA NICOLE MANGOLD

Provider Business Mailing Address
First Line	:	1355 13 MILE RD NE
Second Line	:
City	:	SPARTA
State	:	MI
Zip	:	49345-8363
Country	:	US
Telephone Number	:	231-729-1384
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 E DIVISION ST
Second Line	:
City	:	SPARTA
State	:	MI
Zip	:	49345-1328
Country	:	US
Telephone Number	:	231-729-1384
Fax Number	:

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

Provider Enumeration Date	:	02/17/2022
Last Update Date	:	05/07/2026

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Directions to “ CHRISTINA NICOLE MANGOLD ” Practice Location

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