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General NPI Number Information
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NPI Number | 1902938582
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Entity Type | Individual
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Provider Name | SUSAN ANNE EVANS MS/ LPCC
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Gender | Female
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 12/05/2013
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Provider Practice Location Address
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Address Line | 5530 ALLENTOWN RD
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City | ELIDA
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State | OH
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Zip | 45807-9413
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Country | US
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Telephone | 419-339-1605
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Fax |
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Provider Business Mailing Address
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Address Line | 5530 ALLENTOWN RD
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City | ELIDA
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State | OH
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Zip | 45807-9413
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Country | US
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Telephone | 419-339-1605
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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 | E-0002969
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S-0012213
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | KY-1216
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License Number State | KY
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