Provider Demographics
NPI:1538544309
Name:CROSBY, ANGELA MARIE (LMHC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:CROSBY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5902
Mailing Address - Country:US
Mailing Address - Phone:515-227-1708
Mailing Address - Fax:
Practice Address - Street 1:2123 10TH AVE S
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5902
Practice Address - Country:US
Practice Address - Phone:515-227-1708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077028101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health