Provider Demographics
NPI:1477908465
Name:TAYSON, ANGELA MARIE (MA, LPC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:TAYSON
Suffix:
Gender:F
Credentials:MA, LPC
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 1:1056 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-5400
Mailing Address - Country:US
Mailing Address - Phone:231-420-6707
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:1056 ALPINE DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-5400
Practice Address - Country:US
Practice Address - Phone:231-420-6707
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-1114101YP2500X
WYLPC-2028101YP2500X
WI10336-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional