Provider Demographics
NPI:1093960627
Name:EVANS, STEPHANIE CHRISTINE (PSYD, BA, RC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:CHRISTINE
Last Name:EVANS
Suffix:
Gender:F
Credentials:PSYD, BA, RC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 SE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-2203
Mailing Address - Country:US
Mailing Address - Phone:541-278-2222
Mailing Address - Fax:541-276-8405
Practice Address - Street 1:135 SE 1ST ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2203
Practice Address - Country:US
Practice Address - Phone:541-278-2222
Practice Address - Fax:541-276-8405
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2769103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical