Provider Demographics
NPI:1902595564
Name:ANGELA MUCHA LPC & BRIAN SCOTT LPC LLC
Entity Type:Organization
Organization Name:ANGELA MUCHA LPC & BRIAN SCOTT LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:269-547-0074
Mailing Address - Street 1:210 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097-1213
Mailing Address - Country:US
Mailing Address - Phone:269-569-1372
Mailing Address - Fax:
Practice Address - Street 1:413 N GRAND ST STE C
Practice Address - Street 2:
Practice Address - City:SCHOOLCRAFT
Practice Address - State:MI
Practice Address - Zip Code:49087-9203
Practice Address - Country:US
Practice Address - Phone:269-547-0074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty