Healthcare Provider Details

I. General information

NPI: 1114226453
Provider Name (Legal Business Name): ANGELA MICHELE HEADS PH.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 WILCREST DR SUITE 162
HOUSTON TX
77042-3391
US

IV. Provider business mailing address

4726 SILVER FROST DR
HOUSTON TX
77066-4730
US

V. Phone/Fax

Practice location:
  • Phone: 281-536-7479
  • Fax: 281-586-0664
Mailing address:
  • Phone: 281-536-7479
  • Fax: 281-586-0664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number34989
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number34989
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number34989
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number34989
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: