Healthcare Provider Details

I. General information

NPI: 1154460749
Provider Name (Legal Business Name): ASHLEY M EVANS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 FRANCIS ST SUITE 200
SAINT JOSEPH MO
64501-1769
US

IV. Provider business mailing address

6320 PAMELA DR
SAINT JOSEPH MO
64504-3238
US

V. Phone/Fax

Practice location:
  • Phone: 816-236-2398
  • Fax: 816-236-2464
Mailing address:
  • Phone: 816-364-1501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2005001799
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: