Healthcare Provider Details

I. General information

NPI: 1619366713
Provider Name (Legal Business Name): STEPHANIE NICOLE EVANS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4507
US

IV. Provider business mailing address

1350 JOSEPHINE ST APT 107
DENVER CO
80206-2241
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-4949
  • Fax: 303-602-5559
Mailing address:
  • Phone: 720-499-3096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0003960
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: