Provider Demographics
NPI:1164757290
Name:LISA EVANS MA, INC.
Entity Type:Organization
Organization Name:LISA EVANS MA, INC.
Other - Org Name:LISA C. EVANS, MA, LPC COUNSELING AGENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:972-522-8448
Mailing Address - Street 1:PO BOX 2214
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-2214
Mailing Address - Country:US
Mailing Address - Phone:972-522-8448
Mailing Address - Fax:972-429-2164
Practice Address - Street 1:808 S BALLARD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4224
Practice Address - Country:US
Practice Address - Phone:972-522-8448
Practice Address - Fax:972-429-2164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2010-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65594101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty