Provider Demographics
NPI:1750634051
Name:ANGRUM, NEAL W
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:W
Last Name:ANGRUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WASHINGTON ST
Mailing Address - Street 2:SUITE-A
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6757
Mailing Address - Country:US
Mailing Address - Phone:318-388-6808
Mailing Address - Fax:318-388-6893
Practice Address - Street 1:200 WASHINGTON ST
Practice Address - Street 2:SUITE-A
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6757
Practice Address - Country:US
Practice Address - Phone:318-388-6808
Practice Address - Fax:318-388-6893
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health