Provider Demographics
NPI:1073772901
Name:TUGGLE, ANGEL M (REHAB COUNSELOR)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:M
Last Name:TUGGLE
Suffix:
Gender:F
Credentials:REHAB COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2239
Mailing Address - Country:US
Mailing Address - Phone:405-601-2307
Mailing Address - Fax:405-601-3317
Practice Address - Street 1:625 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2239
Practice Address - Country:US
Practice Address - Phone:405-601-2307
Practice Address - Fax:405-601-3317
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200077440AMedicaid