Provider Demographics
NPI:1508378266
Name:ANGELIKA C BABCOCK
Entity Type:Organization
Organization Name:ANGELIKA C BABCOCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIKA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:254-223-0503
Mailing Address - Street 1:3781 E HOLLY PL
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-5301
Mailing Address - Country:US
Mailing Address - Phone:254-223-0503
Mailing Address - Fax:520-335-6585
Practice Address - Street 1:500 E FRY BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-1839
Practice Address - Country:US
Practice Address - Phone:254-223-0503
Practice Address - Fax:520-335-6585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16028101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ192838Medicaid