Provider Demographics
NPI:1730792813
Name:SIM, ANGELA (LPCC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SIM
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 CLEVELAND AVE N STE 316
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5051
Mailing Address - Country:US
Mailing Address - Phone:651-330-3434
Mailing Address - Fax:
Practice Address - Street 1:475 CLEVELAND AVE N STE 316
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5051
Practice Address - Country:US
Practice Address - Phone:651-330-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5196101YM0800X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician