Provider Demographics
NPI:1356823306
Name:PYKE, ANGELA KAY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KAY
Last Name:PYKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:KAY
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 S PINE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-1670
Mailing Address - Country:US
Mailing Address - Phone:541-904-0083
Mailing Address - Fax:541-508-4526
Practice Address - Street 1:220 S PINE ST STE 102
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-1670
Practice Address - Country:US
Practice Address - Phone:541-904-0083
Practice Address - Fax:541-508-4526
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5144101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health