MEDICARE: MRS. MEGAN MYRL EVANS M.A.

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	106H00000X	Marriage & Family Therapist	MI0062	NV

General Provider Information

NPI Number	:	1770727513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN MYRL EVANS M.A.

Provider Business Mailing Address
First Line	:	11296 MESSINA WAY
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89521-4248
Country	:	US
Telephone Number	:	775-240-1875
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 W MOANA LN
Second Line	:	SUITE 2
City	:	RENO
State	:	NV
Zip	:	89509-4775
Country	:	US
Telephone Number	:	775-337-2394
Fax Number	:

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

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	04/23/2009

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