Provider Demographics
NPI:1891240164
Name:PEENE, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PEENE
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 1:3720 SW 141ST AVE
Mailing Address - Street 2:#204
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2382
Mailing Address - Country:US
Mailing Address - Phone:503-335-5975
Mailing Address - Fax:503-335-5974
Practice Address - Street 1:3720 SW 141ST AVE
Practice Address - Street 2:#204
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2382
Practice Address - Country:US
Practice Address - Phone:503-335-5975
Practice Address - Fax:503-335-5974
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor