Provider Demographics
NPI:1538604236
Name:GONZALEZ, EVELYN
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:GONZALEZ
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 1:2362 NGREEN VALLEY PKWY
Mailing Address - Street 2:APT 122
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014
Mailing Address - Country:US
Mailing Address - Phone:512-982-8161
Mailing Address - Fax:
Practice Address - Street 1:2362 N GREEN VALLEY PKWY
Practice Address - Street 2:APT 122
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-3661
Practice Address - Country:US
Practice Address - Phone:512-982-8161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor