Provider Demographics
NPI:1235796772
Name:PHARR, ANGELO D II
Entity Type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:D
Last Name:PHARR
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15606 E 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-2557
Mailing Address - Country:US
Mailing Address - Phone:313-401-2243
Mailing Address - Fax:
Practice Address - Street 1:15606 E 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-2557
Practice Address - Country:US
Practice Address - Phone:313-401-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst