Healthcare Provider Details

I. General information

NPI: 1548937394
Provider Name (Legal Business Name): ANGELICA L BARTHOLOW LPC CANDIDATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1201 ARLINGTON ST STE D
ADA OK
74820-4072
US

IV. Provider business mailing address

1201 ARLINGTON ST STE D
ADA OK
74820-4072
US

V. Phone/Fax

Practice location:
  • Phone: 580-235-0274
  • Fax:
Mailing address:
  • Phone: 580-235-0274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCCANDIDTATE10276
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: