Provider Demographics
NPI:1336175637
Name:SNELLING, ANGELA MENTA (MA LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MENTA
Last Name:SNELLING
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2795 E BIDWELL ST
Mailing Address - Street 2:SUITE 100-189
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6480
Mailing Address - Country:US
Mailing Address - Phone:916-390-1211
Mailing Address - Fax:
Practice Address - Street 1:2795 E BIDWELL ST
Practice Address - Street 2:SUITE 100-189
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6480
Practice Address - Country:US
Practice Address - Phone:916-390-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001376101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004259489Medicaid
CT240001376CT02OtherANTHEM BLUE CROSS & BLUE