Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 34989 | TX |
Y | 103T00000X | Psychologist | 34989 | TX |
N | 103TC1900X | Counseling Psychologist | 34989 | |
N | 103TH0004X | Health Psychologist | 34989 | TX |
N | 103TP2701X | Group Psychotherapist | 34989 | TX |
NPI | 1114226453 |
---|---|
Provider Name | Angela Michele Heads |
First Address | Houston, TX 77066-4730 |
Second Address | Houston, TX 77042-3391 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2011 |
Last Update Date | 25/03/2011 |