MEDICARE: ANGELA MINOR

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1801271820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MINOR

Provider Business Mailing Address
First Line	:	PO BOX 171
Second Line	:
City	:	GREENWOOD
State	:	CA
Zip	:	95635-0171
Country	:	US
Telephone Number	:	530-333-4035
Fax Number	:

Provider Business Practice Location Address
First Line	:	2844 COLOMA ST
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-4406
Country	:	US
Telephone Number	:	530-644-3758
Fax Number	:

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

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	07/21/2015

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Directions to “ ANGELA MINOR ” Practice Location

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