Provider Demographics
NPI:1053826545
Name:COYLE, ANGELA (SCHOOL PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:COYLE
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4841 W LONE DOVE DR
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-4735
Mailing Address - Country:US
Mailing Address - Phone:317-947-8280
Mailing Address - Fax:
Practice Address - Street 1:4841 W LONE DOVE DR
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85658-4735
Practice Address - Country:US
Practice Address - Phone:317-947-8280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1391338103TS0200X
AZ5077742103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool