Provider Demographics
NPI:1578987624
Name:MUTSCHLER, ANGELA LEE I (LMSW, QMHP, QMRP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:LEE
Last Name:MUTSCHLER
Suffix:I
Gender:F
Credentials:LMSW, QMHP, QMRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BELDING ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MI
Mailing Address - Zip Code:48818-5100
Mailing Address - Country:US
Mailing Address - Phone:248-672-2328
Mailing Address - Fax:
Practice Address - Street 1:611 N STATE ST
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888-9702
Practice Address - Country:US
Practice Address - Phone:989-444-9806
Practice Address - Fax:989-831-7578
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010949111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical