Provider Demographics
NPI:1922161579
Name:GIDEON, ANGELA KAY (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAY
Last Name:GIDEON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5417 69TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-1511
Mailing Address - Country:US
Mailing Address - Phone:806-762-5782
Mailing Address - Fax:806-762-0838
Practice Address - Street 1:2402 CANYON LAKES DR
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-2000
Practice Address - Country:US
Practice Address - Phone:806-762-5782
Practice Address - Fax:806-762-0838
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional