Provider Demographics
NPI:1336977875
Name:ANGELES, MARIELA YAZMIN
Entity type:Individual
Prefix:
First Name:MARIELA
Middle Name:YAZMIN
Last Name:ANGELES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 EAGLE RDG
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-5188
Mailing Address - Country:US
Mailing Address - Phone:214-881-8111
Mailing Address - Fax:
Practice Address - Street 1:2862 N BELT LINE RD
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-9388
Practice Address - Country:US
Practice Address - Phone:214-881-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health