Provider Demographics
NPI:1336327857
Name:FLETCHER, ANGELA M (LCPC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:NEILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3270 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83406-6758
Mailing Address - Country:US
Mailing Address - Phone:208-497-0685
Mailing Address - Fax:208-497-0506
Practice Address - Street 1:1820 E 17TH
Practice Address - Street 2:STE 330
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6400
Practice Address - Country:US
Practice Address - Phone:208-497-0685
Practice Address - Fax:208-497-0506
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-10104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000036DDOtherMENTAL HEALTH SERVICES AC