Provider Demographics
NPI:1053671628
Name:PLATZ, EVELYN ELAINE (LPC)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:ELAINE
Last Name:PLATZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 S RIDGECREST AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-8855
Mailing Address - Country:US
Mailing Address - Phone:417-693-4679
Mailing Address - Fax:
Practice Address - Street 1:3345 S RIDGECREST AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-8855
Practice Address - Country:US
Practice Address - Phone:417-693-4679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011016681101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional