Provider Demographics
NPI:1275644056
Name:EVANS, TIMOTHY CRAIG (LPC,CAADAC, MAC, NCC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:CRAIG
Last Name:EVANS
Suffix:
Gender:M
Credentials:LPC,CAADAC, MAC, NCC
Other - Prefix:MR
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC,CAADAC, MAC, NCC
Mailing Address - Street 1:672 WILTSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-1450
Mailing Address - Country:US
Mailing Address - Phone:972-757-4673
Mailing Address - Fax:814-237-2777
Practice Address - Street 1:1221 W WHITEHALL RD
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2627
Practice Address - Country:US
Practice Address - Phone:972-757-4673
Practice Address - Fax:814-237-2777
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000708106H00000X
PAPC002386101YP2500X
PA7252101YA0400X
TX2217101YA0400X
101YP1600X
TX10310101YP2500X
TX23423104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2052LCOtherBCBS PROVIDER #
TX8Z1238OtherBCBS PROVIDER #
TX82600LOtherBCBS PROVIDER #