Healthcare Provider Details

I. General information

NPI: 1245976588
Provider Name (Legal Business Name): DONALD EVANS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 ELM ST STE 2
BOWLING GREEN KY
42101-2277
US

IV. Provider business mailing address

948 ELM ST STE 2
BOWLING GREEN KY
42101-2277
US

V. Phone/Fax

Practice location:
  • Phone: 270-266-1188
  • Fax: 270-908-2880
Mailing address:
  • Phone: 270-266-1188
  • Fax: 270-908-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number256746
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: