Provider Demographics
NPI:1114165693
Name:MYHRE, ANGELA R (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:R
Last Name:MYHRE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 CHALET GARDENS CT
Mailing Address - Street 2:#3
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-4491
Mailing Address - Country:US
Mailing Address - Phone:608-228-0589
Mailing Address - Fax:
Practice Address - Street 1:619 RIVER ST
Practice Address - Street 2:SUITE F
Practice Address - City:BELLEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53508-9188
Practice Address - Country:US
Practice Address - Phone:608-424-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI782-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist