Healthcare Provider Details

I. General information

NPI: 1275999062
Provider Name (Legal Business Name): EBONY EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 STUMPF BLVD STE B7-7
TERRYTOWN LA
70056-3949
US

IV. Provider business mailing address

1799 STUMPF BLVD STE B7-7
TERRYTOWN LA
70056-3949
US

V. Phone/Fax

Practice location:
  • Phone: 504-233-2288
  • Fax: 844-870-0727
Mailing address:
  • Phone: 504-319-2885
  • Fax: 844-870-0727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6083
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: