Provider Demographics
NPI:1235364639
Name:BROWN, ANGELA RAE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:RAE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:RAE
Other - Last Name:SIMPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:931 JUANITA WAY
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-2883
Mailing Address - Country:US
Mailing Address - Phone:541-941-0490
Mailing Address - Fax:800-342-2196
Practice Address - Street 1:1910 ELM AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-1724
Practice Address - Country:US
Practice Address - Phone:541-941-0490
Practice Address - Fax:800-342-2196
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2209101YP2500X, 101YM0800X
ORL2209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional