Healthcare Provider Details

I. General information

NPI: 1063541282
Provider Name (Legal Business Name): ERIN EVANS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 SPENCER ST STE 118
LAS VEGAS NV
89119-5250
US

IV. Provider business mailing address

4055 SPENCER ST STE 118
LAS VEGAS NV
89119-5250
US

V. Phone/Fax

Practice location:
  • Phone: 702-799-7910
  • Fax: 702-799-9712
Mailing address:
  • Phone: 702-799-9710
  • Fax: 702-799-9712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24075
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5171-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: