Healthcare Provider Details

I. General information

NPI: 1942672183
Provider Name (Legal Business Name): ANGELA LEGE M.S., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 W CONGRESS ST
LAFAYETTE LA
70506-6622
US

IV. Provider business mailing address

4640 W CONGRESS ST
LAFAYETTE LA
70506-6622
US

V. Phone/Fax

Practice location:
  • Phone: 337-210-5844
  • Fax: 225-214-1655
Mailing address:
  • Phone: 337-210-5844
  • Fax: 225-214-1655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6343
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6343
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6343
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: