Provider Demographics
NPI:1023180239
Name:HENRY, ANGELA MARIE (MA)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MARIE
Last Name:HENRY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD SHORES
Mailing Address - State:TX
Mailing Address - Zip Code:78657
Mailing Address - Country:US
Mailing Address - Phone:830-265-0197
Mailing Address - Fax:281-421-3484
Practice Address - Street 1:900 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654
Practice Address - Country:US
Practice Address - Phone:830-265-0197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16756LPC103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist