Provider Demographics
NPI:1275815193
Name:HOUSE, ANGELA KAY (LCPC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAY
Last Name:HOUSE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:KAY
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:106 SUELYNN DR
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-1338
Mailing Address - Country:US
Mailing Address - Phone:309-838-2581
Mailing Address - Fax:
Practice Address - Street 1:706 OGLESBY AVE STE 120
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4617
Practice Address - Country:US
Practice Address - Phone:309-838-2581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-008419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional