Healthcare Provider Details

I. General information

NPI: 1538585336
Provider Name (Legal Business Name): ANITA D EVANS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 282
PEWEE VALLEY KY
40056-0282
US

IV. Provider business mailing address

PO BOX 282
PEWEE VALLEY KY
40056-0282
US

V. Phone/Fax

Practice location:
  • Phone: 502-526-1966
  • Fax:
Mailing address:
  • Phone: 502-526-1966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number174590
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: