Provider Demographics
NPI:1518618297
Name:ALVAREZ, EVETTE DIANE (MS)
Entity Type:Individual
Prefix:
First Name:EVETTE
Middle Name:DIANE
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11704 ELM ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4340
Mailing Address - Country:US
Mailing Address - Phone:402-637-6137
Mailing Address - Fax:
Practice Address - Street 1:4545 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-3251
Practice Address - Country:US
Practice Address - Phone:402-504-3612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12865101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health