MEDICARE: MS. RACHEL ERIN EVANS LCSW

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	104100000X	Social Worker	9094598-3502	UT

General Provider Information

NPI Number	:	1932595238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHEL ERIN EVANS LCSW

Provider Business Mailing Address
First Line	:	EMBEDDED BEHAVIORAL HEALTH TEAM 3
Second Line	:	1364 BARKELEY AVE. BLDG 1150
City	:	FORT CARSON
State	:	CO
Zip	:	80913
Country	:	US
Telephone Number	:	719-503-7863
Fax Number	:

Provider Business Practice Location Address
First Line	:	EMBEDDED BEHAVIORAL HEALTH TEAM 3
Second Line	:	1364 BARKELEY AVE. BLDG 1150
City	:	FORT CARSON
State	:	CO
Zip	:	80913
Country	:	US
Telephone Number	:	719-503-7836
Fax Number	:

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

Provider Enumeration Date	:	04/13/2015
Last Update Date	:	02/08/2022

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