Healthcare Provider Details

I. General information

NPI: 1427790492
Provider Name (Legal Business Name): EVAN MEKAIL ANTHONY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 HUDSON LN
MONROE LA
71201-6003
US

IV. Provider business mailing address

1105 HUDSON LN
MONROE LA
71201-6003
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-6500
  • Fax:
Mailing address:
  • Phone: 318-322-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9406
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: