Provider Demographics
NPI:1336448059
Name:ABBOTT, ANGELA LYNN (LMFT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12654 SEVENTH AVE
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-9577
Mailing Address - Country:US
Mailing Address - Phone:760-912-5553
Mailing Address - Fax:
Practice Address - Street 1:9890 COUNTY FARM RD STE 1
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3678
Practice Address - Country:US
Practice Address - Phone:951-358-4544
Practice Address - Fax:951-351-8027
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA137313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty