Provider Demographics
NPI:1386933943
Name:ANGOVE-MILIANTA, ELIZABETH ANNA (BS)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANNA
Last Name:ANGOVE-MILIANTA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:ANNA
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006
Mailing Address - Country:US
Mailing Address - Phone:605-697-2850
Mailing Address - Fax:605-697-2874
Practice Address - Street 1:211 4TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006
Practice Address - Country:US
Practice Address - Phone:605-697-2850
Practice Address - Fax:605-697-2874
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5200060Medicaid