Provider Demographics
NPI:1972809234
Name:ANGELL, MAXINE LORENE (MFT)
Entity type:Individual
Prefix:
First Name:MAXINE
Middle Name:LORENE
Last Name:ANGELL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 SPRING STREET
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574
Mailing Address - Country:US
Mailing Address - Phone:707-290-5020
Mailing Address - Fax:
Practice Address - Street 1:2101 SPRING STREET
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574
Practice Address - Country:US
Practice Address - Phone:707-290-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19902101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health