Provider Demographics
NPI:1003830605
Name:ANGLIN, JOELLA MOHRLAND (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOELLA
Middle Name:MOHRLAND
Last Name:ANGLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 740020
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0020
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:1538 N LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74110-2535
Practice Address - Country:US
Practice Address - Phone:918-400-7001
Practice Address - Fax:539-202-5070
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK205211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR025608000OtherREGENCE BCBS
OR166045OtherHEALTH NET - MHN
ORP00296613OtherRR MEDICARE
395666OtherVALUE OPTIONS
ORJ159901OtherPACIFIC SOURCE
ORR131276Medicare PIN
OR166045OtherHEALTH NET - MHN
OR114958Medicare ID - Type Unspecified