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General NPI Number Information
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NPI Number | 1912214073
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Entity Type | Individual
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Provider Name | DANA JACQUELINE EVANS L.C.P.C.
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Gender | Female
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Dates
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Enumeration Date | 09/09/2010
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 7424 APENNINES DR
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City | FT RILEY
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State | KS
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Zip | 66442-7151
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Country | US
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Telephone | 785-240-2716
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Fax |
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Provider Business Mailing Address
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Address Line | 3922 FORREST CREEK CIR
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City | MANHATTAN
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State | KS
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Zip | 66503-7598
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Country | US
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Telephone | 208-404-3715
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-4405
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License Number State | ID
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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 | LCPC 4918
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License Number State | ID
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