Provider Demographics
NPI:1518256551
Name:MYERS, ANGELA RENEE (LCDC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:MYERS
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 N GOLDER AVE. TRL 48
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79764
Mailing Address - Country:US
Mailing Address - Phone:432-580-2654
Mailing Address - Fax:432-580-2664
Practice Address - Street 1:2000 MAURICE RD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-4811
Practice Address - Country:US
Practice Address - Phone:432-580-2658
Practice Address - Fax:432-580-2664
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11263101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)