Healthcare Provider Details

I. General information

NPI: 1730457052
Provider Name (Legal Business Name): MICHELLE LEA EVANS LPC, NCC, CEDS-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 BRIARGATE BLVD
COLORADO SPRINGS CO
80920-4168
US

IV. Provider business mailing address

1500 BRADFORD CT
WOODLAND PARK CO
80863-3322
US

V. Phone/Fax

Practice location:
  • Phone: 719-578-5132
  • Fax:
Mailing address:
  • Phone: 314-882-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC12432
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2010041594
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0012914
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: