Provider Demographics
NPI:1154452720
Name:ALBRIGHT, EVAN GAGE
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:GAGE
Last Name:ALBRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 OSOS STREET
Mailing Address - Street 2:IN CARE OF TRANSITIONS MHA
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401
Mailing Address - Country:US
Mailing Address - Phone:805-541-0107
Mailing Address - Fax:805-544-0741
Practice Address - Street 1:277 SOUTH STREET
Practice Address - Street 2:IN CARE OF TRANSITIONS MHA
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:805-541-0107
Practice Address - Fax:805-544-0741
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health