MEDICARE: MR. RICHARD J EVANS V MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	RC000512	WA
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1003096983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD J EVANS V MA

Provider Business Mailing Address
First Line	:	4810 WHITNEY ST
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98229-2638
Country	:	US
Telephone Number	:	602-881-2188
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 LAKEWAY DR
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-5236
Country	:	US
Telephone Number	:	360-676-6749
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2007
Last Update Date	:	01/05/2021

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