Healthcare Provider Details

I. General information

NPI: 1689936247
Provider Name (Legal Business Name): ANGELA LANGRECK KRILICH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA MARIE LANGRECK

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N JORDAN AVE IU HEALTH CENTER - CAPS
BLOOMINGTON IN
47405-3190
US

IV. Provider business mailing address

600 N JORDAN AVE IU HEALTH CENTER - CAPS
BLOOMINGTON IN
47405-3190
US

V. Phone/Fax

Practice location:
  • Phone: 812-855-5711
  • Fax:
Mailing address:
  • Phone: 812-855-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39002830A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: