Provider Demographics
NPI:1366920126
Name:BAREFOOT, ANGELA MARIE
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:BAREFOOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8939 STALLINGS DR
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76227-2043
Mailing Address - Country:US
Mailing Address - Phone:214-784-0715
Mailing Address - Fax:
Practice Address - Street 1:8939 STALLINGS DR
Practice Address - Street 2:
Practice Address - City:PROVIDENCE VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:76227-2043
Practice Address - Country:US
Practice Address - Phone:214-784-0715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72841101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional