Healthcare Provider Details

I. General information

NPI: 1841128212
Provider Name (Legal Business Name): HALLIE G EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 N ANKENY BLVD STE 210
ANKENY IA
50023-4163
US

IV. Provider business mailing address

837 SE LAURIE LN
ANKENY IA
50021-3667
US

V. Phone/Fax

Practice location:
  • Phone: 515-705-0174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number125647
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: