Healthcare Provider Details

I. General information

NPI: 1487265591
Provider Name (Legal Business Name): EVELYNN MAAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 W IRONWOOD DR STE 102
COEUR D ALENE ID
83814-1402
US

IV. Provider business mailing address

1221 W IRONWOOD DR STE 102
COEUR D ALENE ID
83814-1402
US

V. Phone/Fax

Practice location:
  • Phone: 208-664-2486
  • Fax: 208-906-0818
Mailing address:
  • Phone: 208-664-2486
  • Fax: 208-906-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: