Provider Demographics
NPI:1164197448
Name:EVANS, DAVID NATHAN
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:NATHAN
Last Name:EVANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 W NEW HOPE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-6785
Mailing Address - Country:US
Mailing Address - Phone:214-664-8472
Mailing Address - Fax:
Practice Address - Street 1:921 W NEW HOPE DR STE 201
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6785
Practice Address - Country:US
Practice Address - Phone:512-633-7839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.009294101YP2500X
TX85134101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional