Provider Demographics
NPI:1144302142
Name:ANGELICH, DAWN KATHLEEN (LMFT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:KATHLEEN
Last Name:ANGELICH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 W BULLARD AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-2464
Mailing Address - Country:US
Mailing Address - Phone:559-431-5276
Mailing Address - Fax:559-431-5277
Practice Address - Street 1:1341 W BULLARD AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-2464
Practice Address - Country:US
Practice Address - Phone:559-431-5276
Practice Address - Fax:559-431-5277
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31745106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist