Active NPI
Angela Pergola, LPC
- Mental Health Counselor
- Phoenix, AZ
National Provider Identifier
1063815520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LPC15331
- Practice address
- 4414 N 19TH Ave
Phoenix, AZ 85015-4114 - Phone
- (160) 228-5550
- Fax
- (602) 285-5551
- NPI assigned
- Sep 29, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LPC15331 | AZ | Primary |
Addresses
Primary practice location
4414 N 19TH Ave
Phoenix, AZ 85015-4114
Mailing address
4414 N 19TH Ave
Phoenix, AZ 85015-4114
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 22, 2025 through Feb 22, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC15331 | AZ | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411948800000",
"number": "1063815520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4414 N 19TH AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850154114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4414 N 19TH AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850154114",
"telephone_number": "160-228-5550",
"fax_number": "602-285-5551"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERGOLA",
"first_name": "ANGELA",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-29",
"last_updated": "2014-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "AZ",
"license": "LPC15331",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.