Provider Demographics
NPI:1023557295
Name:POPPY EVANS LICENSED PROFESSIONAL COUNSELOR
Entity Type:Organization
Organization Name:POPPY EVANS LICENSED PROFESSIONAL COUNSELOR
Other - Org Name:POPPY EVANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:POPPY
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:513-662-9900
Mailing Address - Street 1:3253 N BEND RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-7610
Mailing Address - Country:US
Mailing Address - Phone:513-662-9900
Mailing Address - Fax:513-662-9902
Practice Address - Street 1:3253 N BEND RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-7610
Practice Address - Country:US
Practice Address - Phone:513-662-9900
Practice Address - Fax:513-662-9902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0900042-S101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty