Healthcare Provider Details

I. General information

NPI: 1659873347
Provider Name (Legal Business Name): APRIL LYNN EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 MAHONING AVE NW
WARREN OH
44483-4605
US

IV. Provider business mailing address

150 E MARKET ST
WARREN OH
44481-1141
US

V. Phone/Fax

Practice location:
  • Phone: 330-395-9563
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC1500491
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: