Healthcare Provider Details

I. General information

NPI: 1275644056
Provider Name (Legal Business Name): TIMOTHY CRAIG EVANS LPC,CAADAC, MAC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TIM EVANS LPC,CAADAC, MAC, NCC

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 W WHITEHALL RD
STATE COLLEGE PA
16801-2627
US

IV. Provider business mailing address

672 WILTSHIRE DR
STATE COLLEGE PA
16803-1450
US

V. Phone/Fax

Practice location:
  • Phone: 972-757-4673
  • Fax: 814-237-2777
Mailing address:
  • Phone: 972-757-4673
  • Fax: 814-237-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000708
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC002386
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number7252
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2217
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10310
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number23423
License Number StateTX

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2052LC
Identifier TypeOTHER
Identifier StateTX
Identifier IssuerBCBS PROVIDER #
# 2
Identifier8Z1238
Identifier TypeOTHER
Identifier StateTX
Identifier IssuerBCBS PROVIDER #
# 3
Identifier82600L
Identifier TypeOTHER
Identifier StateTX
Identifier IssuerBCBS PROVIDER #

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: