Provider Demographics
NPI:1972320877
Name:OTT, ANGELA (LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:OTT
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S ROGERS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-3348
Mailing Address - Country:US
Mailing Address - Phone:214-817-2574
Mailing Address - Fax:
Practice Address - Street 1:301 S ROGERS ST STE 201
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-3348
Practice Address - Country:US
Practice Address - Phone:214-817-2574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health