Provider Demographics
NPI:1770191736
Name:EARL, EVA ANN MARIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:EVA ANN
Middle Name:MARIE
Last Name:EARL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 AVENUE H APT 1519
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-2762
Mailing Address - Country:US
Mailing Address - Phone:469-553-8593
Mailing Address - Fax:
Practice Address - Street 1:2315 AVENUE H APT 1519
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-2762
Practice Address - Country:US
Practice Address - Phone:469-553-8593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80324101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor