Provider Demographics
NPI:1093426660
Name:ARMIJO, ANGELICA LEE
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:LEE
Last Name:ARMIJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12064 SW GARDEN PL
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8263
Mailing Address - Country:US
Mailing Address - Phone:503-382-8288
Mailing Address - Fax:
Practice Address - Street 1:12064 SW GARDEN PL
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8263
Practice Address - Country:US
Practice Address - Phone:503-382-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health