Healthcare Provider Details

I. General information

NPI: 1134633498
Provider Name (Legal Business Name): EVAN ESPINOSA PSY. D, PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. EVAN RUSSELL ESPINOSA

II. Dates (important events)

Enumeration Date: 11/24/2017
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 E BASELINE RD STE 111
GILBERT AZ
85234-2739
US

IV. Provider business mailing address

1469 N 1200 W
OREM UT
84057-2449
US

V. Phone/Fax

Practice location:
  • Phone: 801-655-5450
  • Fax: 385-225-9327
Mailing address:
  • Phone: 801-655-5450
  • Fax: 385-225-9327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number21343
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number21343
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY1485
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number21343
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number21343
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number21343
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number21343
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number21343
License Number StateNV
# 9
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number21343
License Number StateTX
# 10
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number21343
License Number StateCO
# 11
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY-004977
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: