MEDICARE: PROF. ANGELA ISOM COUNSELING LICENSE

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	C.1200588	OH

General Provider Information

NPI Number	:	1700320884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. ANGELA ISOM COUNSELING LICENSE

Provider Business Mailing Address
First Line	:	17419 WAYNE DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-3372
Country	:	US
Telephone Number	:	216-592-8521
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 LEE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2572
Country	:	US
Telephone Number	:	216-592-8521
Fax Number	:

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

Provider Enumeration Date	:	12/08/2016
Last Update Date	:	12/08/2016

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