Provider Demographics
NPI:1952729667
Name:SEDILLO, ANGELA (LPC)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:SEDILLO
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 1:13706 RESEARCH BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1838
Mailing Address - Country:US
Mailing Address - Phone:575-635-8316
Mailing Address - Fax:
Practice Address - Street 1:13706 RESEARCH BLVD STE 114
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1838
Practice Address - Country:US
Practice Address - Phone:575-635-8316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75796101YM0800X
NM0167801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18677037Medicaid