Provider Demographics
NPI:1629056718
Name:CASEY, ANGEL M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:M
Last Name:CASEY
Suffix:
Gender:F
Credentials:PHD
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 5
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:UT
Mailing Address - Zip Code:84518-0005
Mailing Address - Country:US
Mailing Address - Phone:435-637-5175
Mailing Address - Fax:
Practice Address - Street 1:324 N 200 E
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2512
Practice Address - Country:US
Practice Address - Phone:435-637-5175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2007-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT376637-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS97552Medicare UPIN