Provider Demographics
NPI:1437568417
Name:EWING, ANGELA R (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:EWING
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1654
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:OR
Mailing Address - Zip Code:97535-1654
Mailing Address - Country:US
Mailing Address - Phone:541-821-0741
Mailing Address - Fax:
Practice Address - Street 1:33 N CENTRAL AVE STE 400
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-5940
Practice Address - Country:US
Practice Address - Phone:541-821-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3513101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional