Provider Demographics
NPI:1043973001
Name:BECK, ANGELA GRACE (LCDC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:GRACE
Last Name:BECK
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12118 WALNUT PARK XING APT 1331
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-6738
Mailing Address - Country:US
Mailing Address - Phone:512-653-1507
Mailing Address - Fax:
Practice Address - Street 1:305 FERGUSON DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-3006
Practice Address - Country:US
Practice Address - Phone:512-339-9757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14028101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)