MEDICARE: ERIN EVANS LCSW

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	1041C0700X	Clinical Social Worker	24075	CA
2	1041C0700X	Clinical Social Worker	5171-C	NV

General Provider Information

NPI Number	:	1063541282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN EVANS LCSW

Provider Business Mailing Address
First Line	:	4055 SPENCER ST STE 118
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5250
Country	:	US
Telephone Number	:	702-799-9710
Fax Number	:	702-799-9712

Provider Business Practice Location Address
First Line	:	4055 SPENCER ST STE 118
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5250
Country	:	US
Telephone Number	:	702-799-7910
Fax Number	:	702-799-9712

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	10/26/2020

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Directions to “ ERIN EVANS LCSW” Practice Location

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