Provider Demographics
NPI:1477881969
Name:LANDRUM, ANGEL (LPC)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:LANDRUM
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 1:3355 BEE CAVE RD STE 601
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6681
Mailing Address - Country:US
Mailing Address - Phone:512-791-3811
Mailing Address - Fax:512-900-2848
Practice Address - Street 1:3355 BEE CAVE RD STE 601
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6681
Practice Address - Country:US
Practice Address - Phone:512-791-3811
Practice Address - Fax:512-900-2848
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63165101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207159901Medicaid