Provider Demographics
NPI:1417624008
Name:NORTON, EVAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:NORTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76711-1412
Mailing Address - Country:US
Mailing Address - Phone:805-305-3479
Mailing Address - Fax:
Practice Address - Street 1:1328 DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-1412
Practice Address - Country:US
Practice Address - Phone:805-305-3479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38361103TF0200X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent