Provider Demographics
NPI:1790819464
Name:EVELYN, DONNA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:EVELYN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31946 MISSION TRL STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4539
Mailing Address - Country:US
Mailing Address - Phone:951-245-7663
Mailing Address - Fax:951-674-6431
Practice Address - Street 1:31946 MISSION TRL
Practice Address - Street 2:STE B
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4539
Practice Address - Country:US
Practice Address - Phone:951-245-7663
Practice Address - Fax:951-674-6431
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15795103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical