Provider Demographics
NPI:1679280457
Name:WALL, ANGELA B (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:B
Last Name:WALL
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 1:8933 E UNION AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1357
Mailing Address - Country:US
Mailing Address - Phone:720-331-3016
Mailing Address - Fax:
Practice Address - Street 1:8933 E UNION AVE STE 220
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1357
Practice Address - Country:US
Practice Address - Phone:720-331-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist