Healthcare Provider Details

I. General information

NPI: 1356011191
Provider Name (Legal Business Name): ANGELA CHRISTENE GAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10297 S MOONLIT RIVERWALK TRL
VAIL AZ
85641-0558
US

IV. Provider business mailing address

10297 S MOONLIT RIVERWALK TRL
VAIL AZ
85641-0558
US

V. Phone/Fax

Practice location:
  • Phone: 520-581-7992
  • Fax:
Mailing address:
  • Phone: 405-227-5424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-24013
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-24013
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: