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General NPI Number Information
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NPI Number | 1639731813
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Entity Type | Individual
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Provider Name | MR. KODY LEE EVANS
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Gender | Male
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 15620 NE WOODINVILLE DUVALL PL STE 8A
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City | WOODINVILLE
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State | WA
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Zip | 98072-5209
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Country | US
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Telephone | 425-584-2880
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Fax |
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Provider Business Mailing Address
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Address Line | 15061 NE 173RD ST
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City | WOODINVILLE
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State | WA
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Zip | 98072-9216
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Country | US
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Telephone | 425-584-2880
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF61374200
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License Number State | WA
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