Provider Demographics
NPI:1477586154
Name:LEITE, EVELYN M (MHRLPC)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:M
Last Name:LEITE
Suffix:
Gender:F
Credentials:MHRLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9702
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-9702
Mailing Address - Country:US
Mailing Address - Phone:605-484-0576
Mailing Address - Fax:605-399-3250
Practice Address - Street 1:2650 JACKSON BLVD
Practice Address - Street 2:CREEKSIDE PLAZA
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3474
Practice Address - Country:US
Practice Address - Phone:605-484-0576
Practice Address - Fax:605-399-3250
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC697101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDLPC697OtherLICENSED PROFESSIONAL COU