Provider Demographics
NPI:1306909759
Name:LEEK, ANGELA MCMATH (MA, LMFT, LPC)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MCMATH
Last Name:LEEK
Suffix:
Gender:F
Credentials:MA, LMFT, LPC
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
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Mailing Address - Street 1:230 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-5934
Mailing Address - Country:US
Mailing Address - Phone:479-668-3688
Mailing Address - Fax:866-649-6788
Practice Address - Street 1:230 W CENTER ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5934
Practice Address - Country:US
Practice Address - Phone:479-668-3688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45155106H00000X
ARP1710368101YP2500X
ARM1303002106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist