Provider Demographics
NPI:1386822864
Name:LAROCQUE, ANGELA R (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:R
Last Name:LAROCQUE
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:1300 HOSPITAL LOOP
Mailing Address - Street 2:QUENTIN N. BURDICK MEMORIAL HEALTH CARE FACILITY
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316
Mailing Address - Country:US
Mailing Address - Phone:701-477-6111
Mailing Address - Fax:701-477-2509
Practice Address - Street 1:1300 HOSPITAL LOOP
Practice Address - Street 2:QUENTIN N. BURDICK MEMORIAL HEALTH CARE FACILITY
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316
Practice Address - Country:US
Practice Address - Phone:701-477-6111
Practice Address - Fax:701-477-2509
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND408103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1460127Medicaid
ND350063Medicare PIN