Healthcare Provider Details

I. General information

NPI: 1417120643
Provider Name (Legal Business Name): ANGELA RAINEY BURCIAGA MS, LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 FM 2920 RD
SPRING TX
77388-3428
US

IV. Provider business mailing address

2929 FM 2920 RD STE 100
SPRING TX
77388-3428
US

V. Phone/Fax

Practice location:
  • Phone: 281-210-1500
  • Fax:
Mailing address:
  • Phone: 281-210-1500
  • Fax: 713-457-0945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19867
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: