Provider Demographics
NPI:1972213718
Name:SOTO VAN DER PLAS, EVELIEN CHRISTINA
Entity type:Individual
Prefix:
First Name:EVELIEN
Middle Name:CHRISTINA
Last Name:SOTO VAN DER PLAS
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 1:138 FOREST AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-3375
Mailing Address - Country:US
Mailing Address - Phone:224-704-7647
Mailing Address - Fax:
Practice Address - Street 1:2 UPPER RAGSDALE DR # A
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5736
Practice Address - Country:US
Practice Address - Phone:831-642-6201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT135839106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist