Provider Demographics
NPI:1700852381
Name:PONDER, EVA G (PSYD, LCSW, HSPP, LP)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:G
Last Name:PONDER
Suffix:
Gender:F
Credentials:PSYD, LCSW, HSPP, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28465 RANCH ROAD 12
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-3795
Mailing Address - Country:US
Mailing Address - Phone:512-265-5455
Mailing Address - Fax:219-237-9872
Practice Address - Street 1:28465 RANCH ROAD 12
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-3795
Practice Address - Country:US
Practice Address - Phone:512-265-5455
Practice Address - Fax:219-237-9872
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008087103T00000X
IN20042401A103T00000X
IL149.0118301041C0700X
IN34004994A1041C0700X
TX38805103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical