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General NPI Number Information
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NPI Number | 1346418753
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Entity Type | Individual
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Provider Name | KEITH EVASHEVSKI PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 1050 N 3RD ST SUITE B1
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City | LARAMIE
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State | WY
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Zip | 82072-2544
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Country | US
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Telephone | 307-742-9766
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Fax |
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Provider Business Mailing Address
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Address Line | 1214 SHIELD ST
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City | LARAMIE
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State | WY
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Zip | 82072-2244
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Country | US
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Telephone | 307-761-0615
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 382
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License Number State | WY
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