Healthcare Provider Details

I. General information

NPI: 1245938281
Provider Name (Legal Business Name): MICHAEL GAGE EVANS LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6435 E BROAD ST
COLUMBUS OH
43213-1507
US

IV. Provider business mailing address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-8160
  • Fax: 614-355-8180
Mailing address:
  • Phone: 614-722-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2607592
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: