Provider Demographics
NPI:1417086919
Name:EVANS MARRIAGE & FAMILY THERAPY CORPORATION
Entity Type:Organization
Organization Name:EVANS MARRIAGE & FAMILY THERAPY CORPORATION
Other - Org Name:PHILLIP F. EVANS, II, MS, LICENSED MARRIAGE & FAMILY THERAPIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:II
Authorized Official - Credentials:MS, MFT
Authorized Official - Phone:510-724-8255
Mailing Address - Street 1:1563 SOLANO AVE
Mailing Address - Street 2:# 275
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2116
Mailing Address - Country:US
Mailing Address - Phone:510-724-8255
Mailing Address - Fax:510-526-1635
Practice Address - Street 1:1563 SOLANO AVE
Practice Address - Street 2:# 275
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2116
Practice Address - Country:US
Practice Address - Phone:510-724-8255
Practice Address - Fax:510-526-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41687106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty