Provider Demographics
NPI:1073775540
Name:EVANS, MERRILL L (LSCSW)
Entity Type:Individual
Prefix:
First Name:MERRILL
Middle Name:L
Last Name:EVANS
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 WAKARUSA DR STE 2100
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4775
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:785-843-6744
Practice Address - Street 1:1311 WAKARUSA DR STE 2100
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4775
Practice Address - Country:US
Practice Address - Phone:785-424-7770
Practice Address - Fax:785-843-6744
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS71301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004348950002Medicaid