Provider Demographics
NPI:1477703320
Name:JANUTOLO, ANGELA (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:JANUTOLO
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10412 ALLISONVILLE ROAD
Mailing Address - Street 2:STE 105
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2033
Mailing Address - Country:US
Mailing Address - Phone:317-578-9200
Mailing Address - Fax:317-578-9201
Practice Address - Street 1:10412 ALLISONVILLE ROAD
Practice Address - Street 2:STE 105
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2033
Practice Address - Country:US
Practice Address - Phone:317-578-9200
Practice Address - Fax:317-578-9201
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002251A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health