Provider Demographics
NPI:1124826003
Name:BIRCH, ANGEL RENEE (LPCC)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:RENEE
Last Name:BIRCH
Suffix:
Gender:
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MULBERRY ST STE A
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41314-7505
Mailing Address - Country:US
Mailing Address - Phone:606-593-6023
Mailing Address - Fax:
Practice Address - Street 1:200 MULBERRY ST STE A
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41314-7505
Practice Address - Country:US
Practice Address - Phone:606-593-6023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY297557101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional