Provider Demographics
NPI:1184035412
Name:JAGPAT-O'HALLORAN, EVELYN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:
Last Name:JAGPAT-O'HALLORAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:JAGPAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:12028 PEPPERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-1948
Mailing Address - Country:US
Mailing Address - Phone:512-297-2554
Mailing Address - Fax:
Practice Address - Street 1:12028 PEPPERIDGE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-1948
Practice Address - Country:US
Practice Address - Phone:512-297-2554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36357103TB0200X, 103TC0700X, 103TH0004X, 103TH0100X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy