Provider Demographics
NPI:1346463163
Name:EVANS, PAULA ANN (MFT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:ANN
Last Name:EVANS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 W MARCH LN STE 1D
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6420
Mailing Address - Country:US
Mailing Address - Phone:209-473-4211
Mailing Address - Fax:209-473-0610
Practice Address - Street 1:2155 W MARCH LN
Practice Address - Street 2:1D
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6420
Practice Address - Country:US
Practice Address - Phone:209-473-4211
Practice Address - Fax:209-473-0610
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT23384106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist