Provider Demographics
NPI:1174362891
Name:MAYNARD, ANGELA (LLPC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 CRAMTON AVE NE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-8752
Mailing Address - Country:US
Mailing Address - Phone:616-328-1833
Mailing Address - Fax:
Practice Address - Street 1:2465 BYRON STATION DR SW
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9482
Practice Address - Country:US
Practice Address - Phone:616-499-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional