Provider Demographics
NPI:1285232645
Name:AVILA, ANGELO (LMHCA)
Entity Type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:
Last Name:AVILA
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 ADAMS AVE APT D302
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6578
Mailing Address - Country:US
Mailing Address - Phone:310-569-3140
Mailing Address - Fax:
Practice Address - Street 1:119 N COMMERCIAL ST, BELLINGHAM, WA 98225
Practice Address - Street 2:SUITE 950A
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-8048
Practice Address - Country:US
Practice Address - Phone:360-734-5458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WAMC61091501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health