MEDICARE: MATTHEW J EVANS LPC

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	101YM0800X	Mental Health Counselor	12000125	WI

General Provider Information

NPI Number	:	1073469854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW J EVANS LPC

Provider Business Mailing Address
First Line	:	734 N EDGEFIELD AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-3615
Country	:	US
Telephone Number	:	469-258-3775
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 N PROSPECT AVE UNIT 1806
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-6710
Country	:	US
Telephone Number	:	469-258-3775
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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