=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669262028
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAITLIN EVANS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2025
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1505 SATANK ROAD
-----------------------------------------------------
City | CARBONDALE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-963-9647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1115
-----------------------------------------------------
City | BASALT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81621-1115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-925-5858
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPCC.0022538
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225600000X
-----------------------------------------------------
Taxonomy Name | Dance Therapist
-----------------------------------------------------
License Number | 2936
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------