Provider Demographics
NPI:1922164516
Name:FANOELE-GIFFORD, ANGELA KRISTINE (LMHP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KRISTINE
Last Name:FANOELE-GIFFORD
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11605 ARBOR ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2982
Mailing Address - Country:US
Mailing Address - Phone:402-330-4700
Mailing Address - Fax:
Practice Address - Street 1:11605 ARBOR ST
Practice Address - Street 2:SUITE 106
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2982
Practice Address - Country:US
Practice Address - Phone:402-330-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2845101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health