Provider Demographics
NPI:1083126080
Name:ALLPHIN, ANGELA GRACE (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:GRACE
Last Name:ALLPHIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:GRACE
Other - Last Name:STRODTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 W MORRISON, BOX 6
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MO
Mailing Address - Zip Code:65248
Mailing Address - Country:US
Mailing Address - Phone:660-537-3537
Mailing Address - Fax:
Practice Address - Street 1:600 W MORRISON ST # 39
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248-1471
Practice Address - Country:US
Practice Address - Phone:660-537-3537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017025526101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490058763Medicaid