Provider Demographics
NPI:1346565223
Name:EVANS, TONYA G (M ED BCBA)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:G
Last Name:EVANS
Suffix:
Gender:F
Credentials:M ED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 12TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-5804
Mailing Address - Country:US
Mailing Address - Phone:206-257-0946
Mailing Address - Fax:
Practice Address - Street 1:116 12TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-5804
Practice Address - Country:US
Practice Address - Phone:206-257-0946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602748388103K00000X
WA1-07-3378103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst