Provider Demographics
NPI:1417151267
Name:LA LUZERNE, ANGELA (LCSW, LISW, LCADC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:LA LUZERNE
Suffix:
Gender:F
Credentials:LCSW, LISW, LCADC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:BAUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LISW, LCADC
Mailing Address - Street 1:3775 EP TRUE PKWY
Mailing Address - Street 2:PMB #193
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-7696
Mailing Address - Country:US
Mailing Address - Phone:702-306-0368
Mailing Address - Fax:
Practice Address - Street 1:4949 WESTOWN PKWY STE 100
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6704
Practice Address - Country:US
Practice Address - Phone:515-344-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV324-LC101Y00000X
NV5471-S104100000X
CA1202921041C0700X
IA1066971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker