Provider Demographics
NPI:1639779143
Name:SHAH, ANGELA JAGDISH (MS, ACMHC, LPCC, MED)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:JAGDISH
Last Name:SHAH
Suffix:
Gender:F
Credentials:MS, ACMHC, LPCC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13916 BUNNY HOP LN
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9469
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:791 CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-7112
Practice Address - Country:US
Practice Address - Phone:719-289-4946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13984296-6009101YM0800X
COLPCC.0022254101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLPCC.0022254OtherLICENSED PROFESSIONAL COUNSELOR CANDIDATE
UT13984296-6009OtherASSOCIATE CLINICAL MENTAL HEALTH COUNSELOR