Provider Demographics
NPI:1437756079
Name:EVANS, BETHANY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 OGLETHORPE LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TX
Mailing Address - Zip Code:76227-7910
Mailing Address - Country:US
Mailing Address - Phone:832-264-1493
Mailing Address - Fax:
Practice Address - Street 1:405 STATE HIGHWAY 121 BYP STE A250
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4183
Practice Address - Country:US
Practice Address - Phone:832-264-1494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37531103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical