Provider Demographics
NPI:1730696766
Name:MANTSCH, ANGELLA OKAWA (LMFT)
Entity type:Individual
Prefix:
First Name:ANGELLA
Middle Name:OKAWA
Last Name:MANTSCH
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 1:1508 F ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-1609
Mailing Address - Country:US
Mailing Address - Phone:510-883-3179
Mailing Address - Fax:
Practice Address - Street 1:1508 F ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-1609
Practice Address - Country:US
Practice Address - Phone:510-883-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83306106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist