MEDICARE: EVANS COUNSELING, LLC

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	251S00000X	Community/Behavioral Health Agency	59708823501	UT

General Provider Information

NPI Number	:	1053596064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVANS COUNSELING, LLC

Provider Business Mailing Address
First Line	:	1308 S 1700 E
Second Line	:	STE 210
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-2273
Country	:	US
Telephone Number	:	801-582-0208
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 S 1700 E
Second Line	:	STE 210
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-2273
Country	:	US
Telephone Number	:	801-582-0208
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MS. ANNE EVANS-CAZIER
Credential	:	LCSW
Telephone Number	:	801-582-0208

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	01/09/2008

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