Provider Demographics
NPI:1134297773
Name:EVANS, AMY MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 MILLS WAY
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-4022
Mailing Address - Country:US
Mailing Address - Phone:805-571-8868
Mailing Address - Fax:805-571-8868
Practice Address - Street 1:106 W MISSION ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2819
Practice Address - Country:US
Practice Address - Phone:805-403-8867
Practice Address - Fax:805-571-8868
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35427106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist