Healthcare Provider Details

I. General information

NPI: 1255148144
Provider Name (Legal Business Name): KHLOE EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2053 MAPLEWOOD LN
PENDLETON IN
46064-4803
US

IV. Provider business mailing address

2053 MAPLEWOOD LN
PENDLETON IN
46064-4803
US

V. Phone/Fax

Practice location:
  • Phone: 765-609-9090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: