Provider Demographics
NPI:1770097271
Name:FITZGERALD, EVELYNE KIMBRIEL (LPC-S)
Entity type:Individual
Prefix:DR
First Name:EVELYNE
Middle Name:KIMBRIEL
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S FRAZIER ST STE 114
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-4410
Mailing Address - Country:US
Mailing Address - Phone:936-730-5557
Mailing Address - Fax:
Practice Address - Street 1:1300 S FRAZIER ST STE 114
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-4410
Practice Address - Country:US
Practice Address - Phone:936-730-5557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15554103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling