Provider Demographics
NPI:1235480625
Name:EVANS, ELLEN R
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:R
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:R
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5910 CLARK RD
Mailing Address - Street 2:STE. W
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4856
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5910 CLARK RD
Practice Address - Street 2:STE. W
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4856
Practice Address - Country:US
Practice Address - Phone:530-872-6328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health