Provider Demographics
NPI:1386783090
Name:EDWARDS-MATHESON, ANGELA (ASUDC, LCMHC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:EDWARDS-MATHESON
Suffix:
Gender:F
Credentials:ASUDC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 N 100 E STE 3
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2505
Mailing Address - Country:US
Mailing Address - Phone:435-229-7178
Mailing Address - Fax:435-215-2797
Practice Address - Street 1:165 N 100 E STE 3
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2505
Practice Address - Country:US
Practice Address - Phone:435-229-7178
Practice Address - Fax:435-215-2797
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5223421-6006101YA0400X
UT5223421-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5223421-6006OtherSTATE LICENSE
UT5223421-6004OtherSTATE LICENSE