Provider Demographics
NPI:1548062185
Name:VEGA, EVEANNE LIPPOLD
Entity type:Individual
Prefix:
First Name:EVEANNE
Middle Name:LIPPOLD
Last Name:VEGA
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 1:644 1/2 STARLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-4218
Mailing Address - Country:US
Mailing Address - Phone:760-296-0148
Mailing Address - Fax:
Practice Address - Street 1:644 1/2 STARLIGHT DR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-4218
Practice Address - Country:US
Practice Address - Phone:760-296-0148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health