Individual
ANGELA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1901 MEDI PARK DR STE 216, AMARILLO, TX 79106-2110
(806) 552-9700
Mailing address
PO BOX 50026, AMARILLO, TX 79159-0026
(806) 552-9700
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
20208
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
416078001
—
TX
01
—
77385
TEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS
TX
Enumeration date
11/20/2019
Last updated
04/24/2023
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