Provider Demographics
NPI:1841877818
Name:SUMMERSET, ANGELIQUE (LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:
Last Name:SUMMERSET
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14200 THE LAKES BLVD APT 231
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3779
Mailing Address - Country:US
Mailing Address - Phone:904-859-5335
Mailing Address - Fax:
Practice Address - Street 1:313 E ANDERSON LN STE 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1236
Practice Address - Country:US
Practice Address - Phone:904-859-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX95039101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTX82012OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS