Healthcare Provider Details

I. General information

NPI: 1407541568
Provider Name (Legal Business Name): JULIANNA KATHERINE LANGE EVANS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 DIAMOND DR
LOS ALAMOS NM
87544-1739
US

IV. Provider business mailing address

1788 34TH ST
LOS ALAMOS NM
87544-2104
US

V. Phone/Fax

Practice location:
  • Phone: 303-888-3098
  • Fax:
Mailing address:
  • Phone: 303-888-3098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2026-0345
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: