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General NPI Number Information
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NPI Number | 1982128815
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Entity Type | Individual
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Provider Name | MICHAEL ANDREW EVANS LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/02/2017
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 4470 W SUNSET BLVD STE 107
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City | LOS ANGELES
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State | CA
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Zip | 90027-6309
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Country | US
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Telephone | 323-968-6182
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Fax |
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Provider Business Mailing Address
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Address Line | 5005 LA MART DR STE 106
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City | RIVERSIDE
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State | CA
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Zip | 92507-5991
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Country | US
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Telephone | 951-235-7815
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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 | 115410
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License Number State | CA
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