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General NPI Number Information
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NPI Number | 1609336619
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Entity Type | Individual
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Provider Name | CRYSTAL EVANS LPC
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Gender | Female
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 216 OLIVE ST STE 210
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City | TEXARKANA
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State | AR
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Zip | 71854-5932
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Country | US
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Telephone | 903-556-9416
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Fax |
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Provider Business Mailing Address
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Address Line | 1156 LITTLE RIVER 11
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City | ASHDOWN
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State | AR
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Zip | 71822-8985
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Country | US
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Telephone | 903-276-1399
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A1903040
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P2104014
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License Number State | AR
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