Provider Demographics
NPI:1033161690
Name:EVANS, WILLIAM SPENCER (MSW LCSW BCD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:SPENCER
Last Name:EVANS
Suffix:
Gender:M
Credentials:MSW LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NORTH LAST CHANCE GULCH
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4144
Mailing Address - Country:US
Mailing Address - Phone:406-443-1990
Mailing Address - Fax:406-443-1391
Practice Address - Street 1:111 NORTH LAST CHANCE GULCH
Practice Address - Street 2:SUITE 2A
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4144
Practice Address - Country:US
Practice Address - Phone:406-443-1990
Practice Address - Fax:406-443-1391
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT000051041C0700X
MTLCSW#5104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0500253Medicaid
07002-0OtherBC/BS
MT0000500253Medicaid
M000008047Medicare PIN
07002-0OtherBC/BS