Basic Information
| Provider Information | |||||||||
| NPI: | 1710328109 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LPCC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | PLATEK | ||||||||
| OtherFirstName: | ANGELA | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 202 E BAGLEY RD | ||||||||
| Address2: | |||||||||
| City: | BEREA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440172058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402608300 | ||||||||
| FaxNumber: | 4402608305 | ||||||||
| Practice Location | |||||||||
| Address1: | 3094 W MARKET ST | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | FAIRLAWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443333626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402602916 | ||||||||
| FaxNumber: | 3309839310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2013 | ||||||||
| LastUpdateDate: | 09/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 101YP2500X | E.1200647 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.