Provider Demographics
NPI:1104539196
Name:IRELAN, ANGELA MARY (COUNSELING INTERN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARY
Last Name:IRELAN
Suffix:
Gender:F
Credentials:COUNSELING INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 KROMER AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4125
Mailing Address - Country:US
Mailing Address - Phone:360-865-1588
Mailing Address - Fax:
Practice Address - Street 1:3305 OAKES AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4409
Practice Address - Country:US
Practice Address - Phone:425-338-7589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61477679101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health