Provider Demographics
NPI:1083103105
Name:EVANS FAMILY COUNSELING
Entity Type:Organization
Organization Name:EVANS FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-282-4547
Mailing Address - Street 1:270 PIONEER LN
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8826
Mailing Address - Country:US
Mailing Address - Phone:501-282-4547
Mailing Address - Fax:888-313-1371
Practice Address - Street 1:1401 MALVERN AVE STE 152
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6370
Practice Address - Country:US
Practice Address - Phone:501-701-0088
Practice Address - Fax:888-313-1371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7186-C261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)