1194060434 NPI number — DR. ANGELA K WAGGONER PH.D., LPC-S , NCC

Table of content: DR. ANGELA K WAGGONER PH.D., LPC-S , NCC (NPI 1194060434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194060434 NPI number — DR. ANGELA K WAGGONER PH.D., LPC-S , NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAGGONER
Provider First Name:
ANGELA
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., LPC-S , NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194060434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4808 FAIRMONT PKWY # 361
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77505-3722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-678-4622
Provider Business Mailing Address Fax Number:
832-872-2033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7433 HINSDALE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77505-1113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-678-4622
Provider Business Practice Location Address Fax Number:
832-872-2033
Provider Enumeration Date:
11/27/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  65480 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 65480 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 0701007809 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YS0200X , with the licence number: 1245389 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0701007809 . This is a "LICENSED PROFESSIONAL COUNSELOR - SUPERVISOR" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 65480 . This is a "LICENSED PROFESSIONAL COUNSELOR - SUPERVISOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8267 . This is a "LICENSED PROFESSIONAL COUNSELOR - SUPERVISOR" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".