Provider Demographics
NPI:1992934483
Name:LARERY, ANGELA R (PHD)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:R
Last Name:LARERY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:52 SUGAR CREEK CENTER BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-2207
Mailing Address - Country:US
Mailing Address - Phone:832-794-7513
Mailing Address - Fax:713-432-8033
Practice Address - Street 1:52 SUGAR CREEK CENTER BLVD
Practice Address - Street 2:STE 300
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-2207
Practice Address - Country:US
Practice Address - Phone:713-796-9946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34051103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical