Provider Demographics
NPI:1285002865
Name:SEAGRAVES, ANGELA (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:SEAGRAVES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:ANGI
Other - Middle Name:AHLRICH
Other - Last Name:SEAGRAVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:5628 SW GREEN OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1162
Mailing Address - Country:US
Mailing Address - Phone:682-478-5103
Mailing Address - Fax:
Practice Address - Street 1:5628 SW GREEN OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1162
Practice Address - Country:US
Practice Address - Phone:682-478-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-12
Last Update Date:2015-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71794101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional