Provider Demographics
NPI:1891203550
Name:MURILLO, ANGELICA (MSC, LPC-1, LMHC)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:MURILLO
Suffix:
Gender:F
Credentials:MSC, LPC-1, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 WESTWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CANUTILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79835-8904
Mailing Address - Country:US
Mailing Address - Phone:915-820-0911
Mailing Address - Fax:
Practice Address - Street 1:1113 WESTWAY BLVD
Practice Address - Street 2:
Practice Address - City:CANUTILLO
Practice Address - State:TX
Practice Address - Zip Code:79835-8904
Practice Address - Country:US
Practice Address - Phone:915-820-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0194241101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty