Provider Demographics
NPI:1114226453
Name:HEADS, ANGELA MICHELE (PHD,)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELE
Last Name:HEADS
Suffix:
Gender:F
Credentials:PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4726 SILVER FROST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-4730
Mailing Address - Country:US
Mailing Address - Phone:281-536-7479
Mailing Address - Fax:281-586-0664
Practice Address - Street 1:2825 WILCREST DR
Practice Address - Street 2:SUITE 162
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-3391
Practice Address - Country:US
Practice Address - Phone:281-536-7479
Practice Address - Fax:281-586-0664
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34989103T00000X, 103TH0004X, 103TP2701X
34989103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy