Provider Demographics
NPI:1164141735
Name:KNUCKLES, ANGELA KAY (MA, LCPC CANDIDATE)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:KAY
Last Name:KNUCKLES
Suffix:
Gender:F
Credentials:MA, LCPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 LEFF ST APT 6
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3744
Mailing Address - Country:US
Mailing Address - Phone:406-219-1525
Mailing Address - Fax:
Practice Address - Street 1:1145 LEFF ST APT 6
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3744
Practice Address - Country:US
Practice Address - Phone:406-219-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT57117101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health