Healthcare Provider Details

I. General information

NPI: 1124261755
Provider Name (Legal Business Name): ANGELA M. CORBETT LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA MICHELLE BELL LMFT

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 E 2ND ST STE D
AUSTIN TX
78702-4491
US

IV. Provider business mailing address

1430 COLLIER ST
AUSTIN TX
78704-2911
US

V. Phone/Fax

Practice location:
  • Phone: 512-804-3600
  • Fax: 512-476-1469
Mailing address:
  • Phone: 512-445-7787
  • Fax: 512-440-4059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number201268
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: