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General NPI Number Information
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NPI Number | 1790331858
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Entity Type | Individual
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Provider Name | ELISSA CAE EVANS LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 88 E FIDDLERS CANYON RD STE 122
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City | CEDAR CITY
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State | UT
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Zip | 84721-9787
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Country | US
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Telephone | 702-775-2738
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 784
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City | PANACA
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State | NV
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Zip | 89042-0784
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Country | US
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Telephone | 702-461-6484
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 00833-C
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 13063034-3501
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11968-C
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License Number State | NV
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