Provider Demographics
NPI:1154668515
Name:ANGELO, MICHAEL ANTHONY (LCPC)
Entity Type:Individual
Prefix:PROF
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:ANGELO
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4818
Mailing Address - Country:US
Mailing Address - Phone:630-945-0440
Mailing Address - Fax:
Practice Address - Street 1:3270 WESTBURY CT
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-1745
Practice Address - Country:US
Practice Address - Phone:331-575-5035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health