MEDICARE: ANGEL LANDRUM 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	101YP2500X	Professional Counselor	63165	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477881969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL LANDRUM LPC

Provider Business Mailing Address
First Line	:	1221 W BEN WHITE BLVD STE 108A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-7183
Country	:	US
Telephone Number	:	512-791-3811
Fax Number	:	512-812-9938

Provider Business Practice Location Address
First Line	:	1221 W BEN WHITE BLVD STE 108A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-7183
Country	:	US
Telephone Number	:	512-791-3811
Fax Number	:	512-812-9938

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

Provider Enumeration Date	:	11/23/2009
Last Update Date	:	02/18/2026

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Directions to “ ANGEL LANDRUM LPC” Practice Location

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