Provider Demographics
NPI:1568750784
Name:POWELL-BULUTOGLU, ANGELA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:POWELL-BULUTOGLU
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1819
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94927-1819
Mailing Address - Country:US
Mailing Address - Phone:707-585-3700
Mailing Address - Fax:
Practice Address - Street 1:215 N SAN MATEO DR STE 5
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2674
Practice Address - Country:US
Practice Address - Phone:707-779-9132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA903854106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist