Provider Demographics
NPI:1376607853
Name:EVENSON, MERRY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:MERRY
Middle Name:L
Last Name:EVENSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 E WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-1216
Mailing Address - Country:US
Mailing Address - Phone:940-566-0470
Mailing Address - Fax:940-898-2676
Practice Address - Street 1:1605 E WINDSOR DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-1216
Practice Address - Country:US
Practice Address - Phone:940-566-0470
Practice Address - Fax:940-898-2676
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5288101Y00000X, 101YM0800X, 101YP2500X
TX1425106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist