Provider Demographics
NPI:1831262955
Name:ANGELLOZ, CHRISTINE E (PHD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
Last Name:ANGELLOZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 QUAIL RUN DRIVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4128
Mailing Address - Country:US
Mailing Address - Phone:225-767-5650
Mailing Address - Fax:
Practice Address - Street 1:2214 QUAIL RUN DRIVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4128
Practice Address - Country:US
Practice Address - Phone:225-767-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA413103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA56309Medicare ID - Type Unspecified