Provider Demographics
NPI:1780030155
Name:STOTT, ANGELA (CADC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:STOTT
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:MENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 E 800 S APT B216
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-4390
Mailing Address - Country:US
Mailing Address - Phone:208-520-2136
Mailing Address - Fax:
Practice Address - Street 1:675 E. ANDERSON ST.
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401
Practice Address - Country:US
Practice Address - Phone:208-432-1976
Practice Address - Fax:208-278-7956
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCADC-5014101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)