Provider Demographics
NPI:1407886864
Name:EVANS, MONA KAY (MSW, LCSW)
Entity Type:Individual
Prefix:MISS
First Name:MONA
Middle Name:KAY
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 E GANNON DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2663
Mailing Address - Country:US
Mailing Address - Phone:636-931-2900
Mailing Address - Fax:
Practice Address - Street 1:998 E GANNON DR
Practice Address - Street 2:SUITE 120
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2663
Practice Address - Country:US
Practice Address - Phone:636-931-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0020601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO756964508Medicaid
MO1407886864Medicaid
MO1407886864Medicaid