MEDICARE: MRS. ANGELA KAE HESSELBROCK LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	65938	TX

General Provider Information

NPI Number	:	1023394376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA KAE HESSELBROCK LPC

Provider Business Mailing Address
First Line	:	8100 SUN MEADOWS CT
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76123-1960
Country	:	US
Telephone Number	:	817-343-1553
Fax Number	:

Provider Business Practice Location Address
First Line	:	3212 COLLINSWORTH ST
Second Line	:	SUITE 22
City	:	FT WORTH
State	:	TX
Zip	:	76107-6580
Country	:	US
Telephone Number	:	817-343-1553
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2011
Last Update Date	:	06/11/2021

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