=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497886592
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVELYN ANN STONE LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3960 BROADWAY BLVD SUITE 220K
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75043-2593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-523-0083
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3817 GUTHRIE RD
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75043-6245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-523-0083
-----------------------------------------------------
Fax | 972-926-2692
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 35608
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------