Provider Demographics
NPI:1477908465
Name:TAYSON, ANGELA MARIE (MA, PPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:TAYSON
Suffix:
Gender:F
Credentials:MA, PPC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:VALLANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, PPC
Mailing Address - Street 1:300 EAST 17TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4608
Mailing Address - Country:US
Mailing Address - Phone:307-631-9931
Mailing Address - Fax:307-635-7706
Practice Address - Street 1:300 EAST 17TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4608
Practice Address - Country:US
Practice Address - Phone:307-631-9931
Practice Address - Fax:307-635-7706
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-1114101YP2500X
WYLPC-2028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional