Provider Demographics
NPI:1326675539
Name:STANFORD, ANGELA LYNN (LPC TEXAS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:STANFORD
Suffix:
Gender:F
Credentials:LPC TEXAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5222 BREAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-1443
Mailing Address - Country:US
Mailing Address - Phone:469-369-2474
Mailing Address - Fax:
Practice Address - Street 1:4144 N CENTRAL EXPY STE 600-16
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3140
Practice Address - Country:US
Practice Address - Phone:469-369-2474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75440101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional