MEDICARE: ANGELA MICHELE HEADS PH.D,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	34989	TX
2	103TC1900X	Counseling Psychologist	34989
3	103TH0004X	Health Psychologist	34989	TX
4	103TP2701X	Group Psychotherapy Psychologist	34989	TX

General Provider Information

NPI Number	:	1114226453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MICHELE HEADS PH.D,

Provider Business Mailing Address
First Line	:	4726 SILVER FROST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-4730
Country	:	US
Telephone Number	:	281-536-7479
Fax Number	:	281-586-0664

Provider Business Practice Location Address
First Line	:	2825 WILCREST DR
Second Line	:	SUITE 162
City	:	HOUSTON
State	:	TX
Zip	:	77042-3391
Country	:	US
Telephone Number	:	281-536-7479
Fax Number	:	281-586-0664

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	03/25/2011

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