=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811387046
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVANS NEUROPSYCHOLOGY AND THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2015
-----------------------------------------------------
Last Update Date | 01/26/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 OFFICE PARK RD 301
-----------------------------------------------------
City | WEST DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50265-2587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-985-8209
-----------------------------------------------------
Fax | 515-608-4405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 OFFICE PARK RD 301
-----------------------------------------------------
City | WEST DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50265-2587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-985-8209
-----------------------------------------------------
Fax | 515-608-4405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. CATHERINE EVANS
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 515-985-8209
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 00666
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------