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NPI Code Detail

MEDICARE: TINA EVANS

MEDICARE: TINA EVANS
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
1101YP2500XProfessional CounselorC.0004446OH

General Provider Information

NPI Number : 1235639493
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA EVANS
Provider Business Mailing Address
First Line : 1230 STATE ROUTE 314 S
Second Line :
City : MANSFIELD
State : OH
Zip : 44903-9346
Country : US
Telephone Number : 567-395-2251
Fax Number :
Provider Business Practice Location Address
First Line : 40 W 4TH ST
Second Line :
City : MANSFIELD
State : OH
Zip : 44902-1206
Country : US
Telephone Number : 419-522-4969
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2018
Last Update Date : 02/14/2018

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Directions to “ TINA EVANS ” Practice Location

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