Provider Demographics
NPI:1336327857
Name:FLETCHER, ANGELA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:NEILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:IDAHO CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83631-0454
Mailing Address - Country:US
Mailing Address - Phone:208-261-1157
Mailing Address - Fax:
Practice Address - Street 1:1673 W SHORELINE DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6750
Practice Address - Country:US
Practice Address - Phone:208-651-1157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2022-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-7759101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000036DDOtherMENTAL HEALTH SERVICES AC