Provider Demographics
NPI:1881947257
Name:MANGOLD, MAGAN NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:MAGAN
Middle Name:NICOLE
Last Name:MANGOLD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 VAN HORN RD
Mailing Address - Street 2:
Mailing Address - City:IOWA PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76367-6226
Mailing Address - Country:US
Mailing Address - Phone:940-631-1375
Mailing Address - Fax:940-687-1494
Practice Address - Street 1:3701 TAFT BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2315
Practice Address - Country:US
Practice Address - Phone:940-631-1375
Practice Address - Fax:940-687-1494
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67576101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health