Provider Demographics
NPI:1174900898
Name:EVANS, ANTOINETTE (MA LMFT)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LMFT
Mailing Address - Street 1:829 SW 142ND PL
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1555
Mailing Address - Country:US
Mailing Address - Phone:206-914-6820
Mailing Address - Fax:
Practice Address - Street 1:12025 115TH AVE NE
Practice Address - Street 2:D 200
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6942
Practice Address - Country:US
Practice Address - Phone:206-914-6820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60557587106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist