Provider Demographics
NPI:1407401110
Name:EVANS, STEVEN GLENN (ACMHC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:GLENN
Last Name:EVANS
Suffix:
Gender:M
Credentials:ACMHC
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 6332
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84402-6332
Mailing Address - Country:US
Mailing Address - Phone:801-648-3665
Mailing Address - Fax:
Practice Address - Street 1:2909 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-3744
Practice Address - Country:US
Practice Address - Phone:888-801-1556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10529433-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health