Provider Demographics
NPI:1811459282
Name:ROBERTS, ANGELA CAROL (CTRS/L)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:CAROL
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CTRS/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5804 N PENNSYLVANIA AVE APT 203B
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7572
Mailing Address - Country:US
Mailing Address - Phone:405-635-4341
Mailing Address - Fax:
Practice Address - Street 1:2129 SW 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-7024
Practice Address - Country:US
Practice Address - Phone:405-713-4851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator