=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619071735
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARIN MARIE EVANS MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5709 MARCONI AVE STE A
-----------------------------------------------------
City | CARMICHAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-481-2973
-----------------------------------------------------
Fax | 916-481-3707
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11496 GOLD COUNTRY BLVD
-----------------------------------------------------
City | GOLD RIVER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-638-1999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 41017
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------