Provider Demographics
NPI:1295302370
Name:SHIELDS, ANGELA (AMFT, CTRS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:AMFT, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S RIVER RD STE A112
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5874
Mailing Address - Country:US
Mailing Address - Phone:435-669-4314
Mailing Address - Fax:
Practice Address - Street 1:720 S RIVER RD STE A112
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-5874
Practice Address - Country:US
Practice Address - Phone:435-922-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11034357-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist