Provider Demographics
NPI:1467693788
Name:DEBRULER, EVANGELINA MELENDEZ (MAED)
Entity Type:Individual
Prefix:
First Name:EVANGELINA
Middle Name:MELENDEZ
Last Name:DEBRULER
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-2967
Mailing Address - Country:US
Mailing Address - Phone:928-348-7040
Mailing Address - Fax:
Practice Address - Street 1:734 W 11TH ST
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-2967
Practice Address - Country:US
Practice Address - Phone:928-348-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool