MEDICARE: MERRILL L EVANS LSCSW

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	7130	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073775540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERRILL L EVANS LSCSW

Provider Business Mailing Address
First Line	:	543 LAWRENCE AVE STE C
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-4217
Country	:	US
Telephone Number	:	785-424-7770
Fax Number	:	833-527-8323

Provider Business Practice Location Address
First Line	:	543 LAWRENCE AVE STE C
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-4217
Country	:	US
Telephone Number	:	785-424-7770
Fax Number	:	833-527-8323

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

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	01/29/2026

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