Provider Demographics
NPI:1689223364
Name:HOLIDAY, ANGELA W
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:W
Last Name:HOLIDAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6051 DAVIS BLVD # 821277
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6385
Mailing Address - Country:US
Mailing Address - Phone:903-261-2726
Mailing Address - Fax:
Practice Address - Street 1:9800 HILLWOOD PKWY STE 140
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-1532
Practice Address - Country:US
Practice Address - Phone:469-215-5106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76576101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health