Healthcare Provider Details

I. General information

NPI: 1194252007
Provider Name (Legal Business Name): CELINA PATRICE EVANS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 METROPOLITAN AVE
LEAVENWORTH KS
66048-1124
US

IV. Provider business mailing address

1719 METROPOLITAN AVE
LEAVENWORTH KS
66048-1124
US

V. Phone/Fax

Practice location:
  • Phone: 913-850-5634
  • Fax: 913-250-6561
Mailing address:
  • Phone: 913-250-5634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: