Provider Demographics
NPI:1427347939
Name:ROLLINS, EVELYN
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 W STATE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-5022
Mailing Address - Country:US
Mailing Address - Phone:801-785-8870
Mailing Address - Fax:801-785-9454
Practice Address - Street 1:1344 W STATE RD
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-5022
Practice Address - Country:US
Practice Address - Phone:801-785-8870
Practice Address - Fax:801-785-9454
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT47680582501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist