Provider Demographics
NPI:1154536118
Name:ANTHONY, ANGELA M (MS ED, LMHC, NCC)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:M
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:MS ED, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 CHARLESTON DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-1781
Mailing Address - Country:US
Mailing Address - Phone:319-447-1198
Mailing Address - Fax:
Practice Address - Street 1:1924 D ST SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-2918
Practice Address - Country:US
Practice Address - Phone:319-363-0636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00788101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00788OtherIOWA LICENSURE
IA20-4845821OtherEMPLOYER ID NUMBER