Provider Demographics
NPI:1689970063
Name:MYERS, ANGELENE MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELENE
Middle Name:MARIE
Last Name:MYERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:MARIE
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:4880 DRY STONE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-5165
Mailing Address - Country:US
Mailing Address - Phone:719-659-8357
Mailing Address - Fax:
Practice Address - Street 1:6745 RANGEWOOD DR STE 230
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-7105
Practice Address - Country:US
Practice Address - Phone:719-659-8357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2912101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional