Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 36357 | TX |
Y | 103G00000X | Clinical Psychologist | 36357 | TX |
Y | 103TC0700X | Clinical Psychologist | 36357 | TX |
N | 103TH0004X | Health Psychologist | 36357 | TX |
N | 103TH0100X | Health Service | 36357 | TX |
N | 103TP2701X | Group Psychotherapist | 36357 | TX |
NPI | 1184035412 |
---|---|
Provider Name | Dr. Evelyn Jagpat-O'halloran |
First Address | Austin, TX 78739-1948 |
Second Address | Austin, TX 78739-1948 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2014 |
Last Update Date | 08/05/2014 |