Provider Demographics
NPI:1124595491
Name:KHOSHNOUD, ANGELA (AM, LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:KHOSHNOUD
Suffix:
Gender:F
Credentials:AM, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12401 E 17TH AVE
Mailing Address - Street 2:MAIL STOP F777
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2548
Mailing Address - Country:US
Mailing Address - Phone:720-553-4528
Mailing Address - Fax:
Practice Address - Street 1:12605 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2545
Practice Address - Country:US
Practice Address - Phone:720-553-4528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099247851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical