Provider Demographics
NPI:1902228349
Name:ALDERMAN, ANGELA MARIE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MARIE
Last Name:ALDERMAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:MARIE
Other - Last Name:ALDERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:324 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-2532
Mailing Address - Country:US
Mailing Address - Phone:918-279-6565
Mailing Address - Fax:918-276-6551
Practice Address - Street 1:324 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429-2532
Practice Address - Country:US
Practice Address - Phone:918-279-6565
Practice Address - Fax:918-279-6551
Is Sole Proprietor?:No
Enumeration Date:2014-01-18
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK5875101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000000000Medicaid