Provider Demographics
NPI:1396053849
Name:PRICE, ANGELA KAYE (MSHR)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAYE
Last Name:PRICE
Suffix:
Gender:F
Credentials:MSHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 N FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-1808
Mailing Address - Country:US
Mailing Address - Phone:918-351-8023
Mailing Address - Fax:
Practice Address - Street 1:1100 COLONY DR
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2342
Practice Address - Country:US
Practice Address - Phone:580-272-5580
Practice Address - Fax:580-272-5554
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
OK5812101YP2500X
TX79073101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional