Provider Demographics
NPI:1639431497
Name:DEANGELIS, MICHAEL DOMINICK (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DOMINICK
Last Name:DEANGELIS
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5268
Mailing Address - Country:US
Mailing Address - Phone:931-218-6100
Mailing Address - Fax:931-477-2377
Practice Address - Street 1:600 S ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5268
Practice Address - Country:US
Practice Address - Phone:931-218-6100
Practice Address - Fax:931-477-2377
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4827101YP2500X, 101YP2500X
TN1-17-29040103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst