Provider Demographics
NPI:1568614865
Name:ANGEL, CASEY LEIGH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:LEIGH
Last Name:ANGEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:LEIGH
Other - Last Name:WOLFINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 1529
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81658-1529
Mailing Address - Country:US
Mailing Address - Phone:970-306-3773
Mailing Address - Fax:970-668-5794
Practice Address - Street 1:439 EDWARDS ACCESS RD
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-5634
Practice Address - Country:US
Practice Address - Phone:970-455-2489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical