Provider Demographics
NPI:1154735397
Name:LAW, ANGELA (LMHC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:LAW
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:WIREMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:311 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-2827
Mailing Address - Country:US
Mailing Address - Phone:574-262-3597
Mailing Address - Fax:574-262-3599
Practice Address - Street 1:311 W HIGH ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-2827
Practice Address - Country:US
Practice Address - Phone:574-262-3597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003196A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health