Healthcare Provider Details

I. General information

NPI: 1093861965
Provider Name (Legal Business Name): CHARLOTTE L EVANS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARLOTTE L EVANS MFT

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 7TH ST
WASCO CA
93280-1820
US

IV. Provider business mailing address

2405 OLYMPIC DR
BAKERSFIELD CA
93308-1811
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-4029
  • Fax:
Mailing address:
  • Phone: 661-399-9542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMFT 20016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: