Provider Demographics
NPI:1922136563
Name:THOMASON, ANGELA BEATRIZ
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:BEATRIZ
Last Name:THOMASON
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 1:2891 IDAHO AVE APT B
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-3606
Mailing Address - Country:US
Mailing Address - Phone:270-697-1095
Mailing Address - Fax:
Practice Address - Street 1:404 PAGEANT LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3865
Practice Address - Country:US
Practice Address - Phone:931-920-2347
Practice Address - Fax:931-553-2347
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor