MEDICARE: MS. CHARLOTTE ANN EVANS MA., LMFT, 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	005465	TX
2	101YM0800X	Mental Health Counselor	15458	TX

General Provider Information

NPI Number	:	1336159722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHARLOTTE ANN EVANS MA., LMFT, LPC

Provider Business Mailing Address
First Line	:	18100 UPPER BAY RD
Second Line	:	SUITE 105
City	:	HOUSTON
State	:	TX
Zip	:	77058-3548
Country	:	US
Telephone Number	:	281-335-9889
Fax Number	:	281-333-8441

Provider Business Practice Location Address
First Line	:	18100 UPPER BAY RD
Second Line	:	SUITE 105
City	:	HOUSTON
State	:	TX
Zip	:	77058-3548
Country	:	US
Telephone Number	:	281-335-9889
Fax Number	:	281-333-8441

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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