Provider Demographics
NPI:1245782317
Name:BLACK, ANGELA (MSC, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:MSC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-6212
Mailing Address - Country:US
Mailing Address - Phone:406-217-3551
Mailing Address - Fax:
Practice Address - Street 1:55 BASIN CREEK RD
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9704
Practice Address - Country:US
Practice Address - Phone:406-496-6314
Practice Address - Fax:406-494-1724
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health