Healthcare Provider Details

I. General information

NPI: 1992439764
Provider Name (Legal Business Name): EVELIN SALDANA GAMA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVELIN SANDOVAL G ASW

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 W HENDERSON AVE
PORTERVILLE CA
93257-1774
US

IV. Provider business mailing address

1086 WESTSIDE ST
PORTERVILLE CA
93257-1433
US

V. Phone/Fax

Practice location:
  • Phone: 559-342-9055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number110064
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number110064
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110064
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: