Provider Demographics
NPI:1427416445
Name:EVANS, COLLEEN (NLC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:NLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4098
Mailing Address - Country:US
Mailing Address - Phone:719-510-7056
Mailing Address - Fax:
Practice Address - Street 1:5350 N ACADEMY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4098
Practice Address - Country:US
Practice Address - Phone:719-510-7056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0104362101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health