Basic Information
| Provider Information | |||||||||
| NPI: | 1114331295 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VALLEJO | ||||||||
| FirstName: | ANGELO | ||||||||
| MiddleName: | ERNESTO | ||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 HANCOCK STREET | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486024224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897973400 | ||||||||
| FaxNumber: | 9897990206 | ||||||||
| Practice Location | |||||||||
| Address1: | SAGINAW COUNTY MENTAL HEALTH | ||||||||
| Address2: | 500 HANCOCK STREET | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486024224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897973400 | ||||||||
| FaxNumber: | 9897990206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2014 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 171M00000X | 6801097595 | MI | N | Other Service Providers | Case Manager/Care Coordinator | 104100000X | 6801097595 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.