Provider Demographics
NPI:1760524706
Name:GARRETT, ANGELA WETZEL (LCPC CCDC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:WETZEL
Last Name:GARRETT
Suffix:
Gender:F
Credentials:LCPC CCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WILLOWBROOK CLOSE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-8100
Mailing Address - Country:US
Mailing Address - Phone:406-885-4696
Mailing Address - Fax:
Practice Address - Street 1:244 SPOKANE AVE
Practice Address - Street 2:SUITE #7
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2677
Practice Address - Country:US
Practice Address - Phone:406-885-4696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT873101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0256269Medicaid