Provider Demographics
NPI:1134633498
Name:ESPINOSA, EVAN (PSY D, APIT)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:ESPINOSA
Suffix:
Gender:M
Credentials:PSY D, APIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 N 1200 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2449
Mailing Address - Country:US
Mailing Address - Phone:801-609-8093
Mailing Address - Fax:385-225-9327
Practice Address - Street 1:3303 E BASELINE RD STE 111
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2739
Practice Address - Country:US
Practice Address - Phone:801-655-5450
Practice Address - Fax:385-225-9327
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-24
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1485103TC0700X
CO21343103TC1900X
AZ21343103TC1900X
FL21343103TC1900X
ID21343103TC1900X
NV21343103TC1900X
WI21343103TC1900X
AZPSY-004977103TC0700X
UT21343103TC1900X
TX21343103TC1900X
WA21343103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty