Healthcare Provider Details

I. General information

NPI: 1043145568
Provider Name (Legal Business Name): EVELYN IVONNE GARCIA GOMEZ M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6807 EMMETT F LOWRY EXPY STE 308
TEXAS CITY TX
77591-2547
US

IV. Provider business mailing address

1350 SHRUB OAK DR
LEAGUE CITY TX
77573-5272
US

V. Phone/Fax

Practice location:
  • Phone: 409-762-8636
  • Fax:
Mailing address:
  • Phone: 787-202-5004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4668
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number96863
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: