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General NPI Number Information
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NPI Number | 1659858157
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Entity Type | Organization
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Legal Business Name | KAREN A EVANS PHD LLC
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 7061 CORPORATE WAY STE 110
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City | DAYTON
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State | OH
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Zip | 45459-4244
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Country | US
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Telephone | 937-307-5949
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Fax |
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Provider Business Mailing Address
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Address Line | 6091 SINGLE TREE LN
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City | DAYTON
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State | OH
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Zip | 45459-2423
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Country | US
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Telephone | 937-307-5949
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. KAREN A EVANS
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Credential | PHD
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Telephone | 937-307-5949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5896
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License Number State | OH
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