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General NPI Number Information
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NPI Number | 1477856524
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Entity Type | Individual
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Provider Name | JOHN S EVANS JR. LCSW, LMFT
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Gender | Male
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 09/01/2011
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Provider Practice Location Address
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Address Line | 2201 S CLEAR CREEK RD METROPLEX PAVILION SUITE A-18
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City | KILLEEN
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State | TX
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Zip | 76549-4110
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Country | US
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Telephone | 254-563-5572
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Fax | 254-778-1599
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Provider Business Mailing Address
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Address Line | 3515 WHITE OAK DR
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City | TEMPLE
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State | TX
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Zip | 76502-3605
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Country | US
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Telephone | 254-778-1599
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Fax | 254-778-1599
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13606
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 460
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License Number State | TX
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