Healthcare Provider Details

I. General information

NPI: 1033161690
Provider Name (Legal Business Name): WILLIAM SPENCER EVANS MSW LCSW BCD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NORTH LAST CHANCE GULCH SUITE 2A
HELENA MT
59601-4144
US

IV. Provider business mailing address

111 NORTH LAST CHANCE GULCH SUITE 2A
HELENA MT
59601-4144
US

V. Phone/Fax

Practice location:
  • Phone: 406-443-1990
  • Fax: 406-443-1391
Mailing address:
  • Phone: 406-443-1990
  • Fax: 406-443-1391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00005
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW#5
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: