Provider Demographics
NPI:1790242907
Name:ANGULO, KELIN JOHANNA
Entity Type:Individual
Prefix:
First Name:KELIN
Middle Name:JOHANNA
Last Name:ANGULO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25602 CAMILLA MAE CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-5076
Mailing Address - Country:US
Mailing Address - Phone:195-450-5936
Mailing Address - Fax:
Practice Address - Street 1:25602 CAMILLA MAE CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-5076
Practice Address - Country:US
Practice Address - Phone:195-450-5936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-24
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X103K00000X
FLRBT-19-88681106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst