Individual
ANGELA M BROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
355 CHURCH STREET, AVINGER, TX 75630
(318) 505-2281
Mailing address
355 CHURCH STREET, AVINGER, TX 75630
(318) 505-2281
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
74360
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
74630
STATE LICENSE NUMBER
TX
Enumeration date
05/18/2017
Last updated
05/18/2017
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