Healthcare Provider Details

I. General information

NPI: 1659047470
Provider Name (Legal Business Name): MISS EVAN BOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5776 STONERIDGE MALL RD STE 340
PLEASANTON CA
94588-4514
US

IV. Provider business mailing address

1333 WILLOW PASS RD STE 200
CONCORD CA
94520-7923
US

V. Phone/Fax

Practice location:
  • Phone: 510-223-8047
  • Fax:
Mailing address:
  • Phone: 925-338-7928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: