Healthcare Provider Details

I. General information

NPI: 1164015095
Provider Name (Legal Business Name): SARA L EVANS MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5124 REFORMATORY RD
PENDLETON IN
46064-8767
US

IV. Provider business mailing address

4502 W LAKE POTOMAC VW APT B
GREENFIELD IN
46140-7355
US

V. Phone/Fax

Practice location:
  • Phone: 765-778-8011
  • Fax:
Mailing address:
  • Phone: 765-729-3035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39003726A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: