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General NPI Number Information
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NPI Number | 1720049471
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Entity Type | Individual
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Provider Name | BRADY EVAN CLEVENGER MS PLPC
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2914 E 32ND ST SUITE 308
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City | JOPLIN
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State | MO
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Zip | 64804-4402
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Country | US
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Telephone | 417-624-8333
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Fax | 417-624-0349
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Provider Business Mailing Address
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Address Line | PO BOX 8225
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City | JOPLIN
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State | MO
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Zip | 64802-8225
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Country | US
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Telephone | 417-624-4960
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2005036369
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License Number State | MO
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