Provider Demographics
NPI:1851986590
Name:LONGORIA, ANGELA LYNN (LMFT-A)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:LONGORIA
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16811 POPLAR HILL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-4139
Mailing Address - Country:US
Mailing Address - Phone:713-306-6128
Mailing Address - Fax:
Practice Address - Street 1:25133 LAKECREST MANOR DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-3185
Practice Address - Country:US
Practice Address - Phone:910-447-9211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health