Healthcare Provider Details

I. General information

NPI: 1972130706
Provider Name (Legal Business Name): AARON JAMES EVANS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 W HIGHLAND BLVD
MILWAUKEE WI
53208-3252
US

IV. Provider business mailing address

6338 W GLENBROOK RD
MILWAUKEE WI
53223-1538
US

V. Phone/Fax

Practice location:
  • Phone: 414-342-4560
  • Fax:
Mailing address:
  • Phone: 414-350-0339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6810-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6810-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: