Healthcare Provider Details

I. General information

NPI: 1659381424
Provider Name (Legal Business Name): RONNIE JAMES EVANS LMHC NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5327 COMMERCIAL WAY C 115
SPRING HILL FL
34606-1448
US

IV. Provider business mailing address

5327 COMMERCIAL WAY C 115
SPRING HILL FL
34606-1448
US

V. Phone/Fax

Practice location:
  • Phone: 352-597-5497
  • Fax: 352-597-1662
Mailing address:
  • Phone: 352-597-5497
  • Fax: 352-597-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH3030
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: