Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003137027 |
---|---|
Provider Name | Mrs. Evelyn Patricia Quezada |
First Address | Yuma, AZ 85365-5427 |
Second Address | Yuma, AZ 85364-6402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2010 |
Last Update Date | 14/06/2010 |