Healthcare Provider Details

I. General information

NPI: 1093627994
Provider Name (Legal Business Name): ATAYSIA EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 66TH ST STE D
LUBBOCK TX
79414-4875
US

IV. Provider business mailing address

4601 66TH ST STE D
LUBBOCK TX
79414-4875
US

V. Phone/Fax

Practice location:
  • Phone: 806-630-0126
  • Fax: 806-722-5225
Mailing address:
  • Phone: 806-630-0126
  • Fax: 806-722-5225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number103549
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: