Provider Demographics
NPI:1114406063
Name:EVANS, MADISON (MS, PLPC, NCC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS, PLPC, NCC
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, PLPC, NCC
Mailing Address - Street 1:2206 RUE SIMONE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5730
Mailing Address - Country:US
Mailing Address - Phone:985-662-1499
Mailing Address - Fax:
Practice Address - Street 1:2206 RUE SIMONE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5730
Practice Address - Country:US
Practice Address - Phone:985-662-1499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-11
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7185101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional