Provider Demographics
NPI:1821132408
Name:MATTHEWS, ANGELA LYNN (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:LYNN
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 INDIGO CIR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2022
Mailing Address - Country:US
Mailing Address - Phone:850-449-1230
Mailing Address - Fax:
Practice Address - Street 1:3815 INDIGO CIR
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2022
Practice Address - Country:US
Practice Address - Phone:850-449-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health