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General NPI Number Information
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NPI Number | 1548430879
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Entity Type | Individual
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Provider Name | JACQUELINE ANGELES M.A., LMFT #93466
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Gender | Female
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 323 N PRAIRIE AVE # 350
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City | INGLEWOOD
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State | CA
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Zip | 90301-4502
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Country | US
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Telephone | 310-677-7808
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Fax |
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Provider Business Mailing Address
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Address Line | 4760 SEPULVEDA BLVD
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City | CULVER CITY
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State | CA
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Zip | 90230-4820
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Country | US
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Telephone | 310-390-6612
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 93466
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License Number State | CA
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