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NPI Code Detail

MEDICARE: MR. DAVID C. EVANS LCPC

MEDICARE: MR. DAVID C. EVANS LCPC
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 CounselorIL

General Provider Information

NPI Number : 1407863186
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID C. EVANS LCPC
Provider Business Mailing Address
First Line : 1644 W COLONIAL PKWY
Second Line :
City : INVERNESS
State : IL
Zip : 60067-1207
Country : US
Telephone Number : 224-628-3654
Fax Number :
Provider Business Practice Location Address
First Line : 1644 W COLONIAL PKWY
Second Line :
City : INVERNESS
State : IL
Zip : 60067-1207
Country : US
Telephone Number : 224-628-3654
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2006
Last Update Date : 07/08/2007

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Directions to “ MR. DAVID C. EVANS LCPC” Practice Location

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