MEDICARE: MS. ANGELA R PRINCE 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	101YM0800X	Mental Health Counselor	19468	TX

General Provider Information

NPI Number	:	1881651446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA R PRINCE LPC

Provider Business Mailing Address
First Line	:	1115 BLOCK ST
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-2709
Country	:	US
Telephone Number	:	409-727-8997
Fax Number	:	409-729-9747

Provider Business Practice Location Address
First Line	:	2721 NALL ST
Second Line	:	C
City	:	PORT NECHES
State	:	TX
Zip	:	77651-5203
Country	:	US
Telephone Number	:	409-727-8997
Fax Number	:	409-729-9747

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/08/2007

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