Provider Demographics
NPI:1619422458
Name:LITTLEFIELD, ANGEL MARIE
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:MARIE
Last Name:LITTLEFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:MARIE
Other - Last Name:BULNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:418 CHENEY ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-0912
Mailing Address - Country:US
Mailing Address - Phone:775-525-1616
Mailing Address - Fax:
Practice Address - Street 1:418 CHENEY ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-0912
Practice Address - Country:US
Practice Address - Phone:755-251-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health