Provider Demographics
NPI:1326199548
Name:EVANS, BEVERLY KAYE (LCSW)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:KAYE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60383
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73146-0383
Mailing Address - Country:US
Mailing Address - Phone:405-848-4459
Mailing Address - Fax:405-848-4459
Practice Address - Street 1:1029 NW 46TH ST
Practice Address - Street 2:#5
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-6447
Practice Address - Country:US
Practice Address - Phone:405-848-4459
Practice Address - Fax:405-848-4459
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical