Provider Demographics
NPI:1639442064
Name:EARLE, ANGELLA A (LMFTI)
Entity Type:Individual
Prefix:
First Name:ANGELLA
Middle Name:A
Last Name:EARLE
Suffix:
Gender:F
Credentials:LMFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6679 CONQUISTADOR ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-1324
Mailing Address - Country:US
Mailing Address - Phone:702-409-6448
Mailing Address - Fax:702-665-4763
Practice Address - Street 1:4160 S PECOS RD STE 21
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5025
Practice Address - Country:US
Practice Address - Phone:702-665-4767
Practice Address - Fax:702-665-4763
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVM10554106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist