Provider Demographics
NPI:1841617610
Name:STANLEY, ANGELA L (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:L
Other - Last Name:MCCLOUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6654
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73506-0654
Mailing Address - Country:US
Mailing Address - Phone:580-583-3858
Mailing Address - Fax:
Practice Address - Street 1:2301 SW 43RD ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8044
Practice Address - Country:US
Practice Address - Phone:580-583-3858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2021-03-26
Deactivation Date:2014-03-28
Deactivation Code:
Reactivation Date:2014-10-16
Provider Licenses
StateLicense IDTaxonomies
OK6222101YP2500X, 171W00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171W00000XOther Service ProvidersContractor