MEDICARE: EARLENE M EVANS LCSW

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	02442C	NV

General Provider Information

NPI Number	:	1932286598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EARLENE M EVANS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 35409
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5409
Country	:	US
Telephone Number	:	702-656-6893
Fax Number	:	702-248-2008

Provider Business Practice Location Address
First Line	:	1885 VILLAGE CENTER CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6369
Country	:	US
Telephone Number	:	702-656-6893
Fax Number	:	702-248-2008

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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Directions to “ EARLENE M EVANS LCSW” Practice Location

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