Provider Demographics
NPI:1508403098
Name:POBANZ, ANGELA L (MA, CMHC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:POBANZ
Suffix:
Gender:F
Credentials:MA, CMHC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:L
Other - Last Name:POBANZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5858 WILLOW BEND RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GREEN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-8725
Mailing Address - Country:US
Mailing Address - Phone:434-258-3635
Mailing Address - Fax:
Practice Address - Street 1:1407 N 2000 W STE A
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-8563
Practice Address - Country:US
Practice Address - Phone:434-258-3635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9681359-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional