MEDICARE: EVEANNE LIPPOLD VEGA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1548062185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVEANNE LIPPOLD VEGA

Provider Business Mailing Address
First Line	:	644 1/2 STARLIGHT DR
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81504-4218
Country	:	US
Telephone Number	:	760-296-0148
Fax Number	:

Provider Business Practice Location Address
First Line	:	644 1/2 STARLIGHT DR
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81504-4218
Country	:	US
Telephone Number	:	760-296-0148
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2025
Last Update Date	:	03/25/2025

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Directions to “ EVEANNE LIPPOLD VEGA ” Practice Location

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