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General NPI Number Information
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NPI Number | 1851433700
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Entity Type | Individual
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Provider Name | MARY BETH EVANS LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 114 COUNTRY CLUB RD
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City | SHERWOOD
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State | AR
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Zip | 72120-4625
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Country | US
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Telephone | 501-834-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 4355 SPRING GLEN DR
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City | SHERWOOD
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State | AR
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Zip | 72120-5112
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Country | US
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Telephone | 501-650-4925
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2245-C
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License Number State | AR
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