=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811638612
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | K EVANS COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2022
-----------------------------------------------------
Last Update Date | 04/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 LAND CREEK CV STE 150
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78746-7652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-632-7258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8612 BROCK CIR
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78745-6368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-632-7258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KAYLE EVANS
-----------------------------------------------------
Credential | LCSW-S, ADS
-----------------------------------------------------
Telephone | 512-632-7258
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------