Provider Demographics
NPI:1174167456
Name:POWELSON, ANGELICA (BCBA)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:POWELSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11341 XAVIER DR UNIT 204
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-6556
Mailing Address - Country:US
Mailing Address - Phone:615-429-8079
Mailing Address - Fax:
Practice Address - Street 1:325 INVERNESS DR S
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-6012
Practice Address - Country:US
Practice Address - Phone:720-507-5226
Practice Address - Fax:720-368-5139
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-19-38638103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician