MEDICARE: MS. THERESA A EVANS MSW, LMSW

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	6801066444	MI

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	:	1972659845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. THERESA A EVANS MSW, LMSW

Provider Business Mailing Address
First Line	:	2506 HOLLAND CIR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49685-7410
Country	:	US
Telephone Number	:	231-409-8622
Fax Number	:	855-855-8105

Provider Business Practice Location Address
First Line	:	3130 LOGAN VALLEY RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-4772
Country	:	US
Telephone Number	:	231-409-8622
Fax Number	:

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	01/26/2026

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