Provider Demographics
NPI:1518629104
Name:MARTIN, ANGELA M (MA, MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA, MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 S CENTER ST STE 301
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2543
Mailing Address - Country:US
Mailing Address - Phone:307-394-2548
Mailing Address - Fax:
Practice Address - Street 1:141 S CENTER ST STE 301
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2543
Practice Address - Country:US
Practice Address - Phone:307-394-2548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-2053101YM0800X, 101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health