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General NPI Number Information
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NPI Number | 1992981864
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Entity Type | Organization
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Legal Business Name | EVANS & EVANS COUNSELING& CONSULTING SERVICES INC
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 1525 E 53RD ST SUITE 531
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City | CHICAGO
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State | IL
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Zip | 60615-4557
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Country | US
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Telephone | 773-752-0531
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Fax | 773-752-3271
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Provider Business Mailing Address
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Address Line | 1525 E 53RD ST SUITE 531
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City | CHICAGO
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State | IL
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Zip | 60615-4557
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Country | US
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Telephone | 773-752-0531
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Fax | 773-752-3271
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT CHARLES EVANS
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Credential | PH.D., LCSW
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Telephone | 773-721-5180
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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 | 149-001022
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-003202
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License Number State | IL
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