Provider Demographics
NPI:1164897385
Name:EVANS, THIPAKHONE (MS)
Entity Type:Individual
Prefix:
First Name:THIPAKHONE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S LEWIS ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4882
Mailing Address - Country:US
Mailing Address - Phone:337-321-9204
Mailing Address - Fax:337-321-9210
Practice Address - Street 1:801 S LEWIS ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4882
Practice Address - Country:US
Practice Address - Phone:337-321-9204
Practice Address - Fax:337-321-9210
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health