Provider Demographics
NPI:1477026839
Name:EVANS ASSESSMENT AND CONSULTATION, LLC
Entity Type:Organization
Organization Name:EVANS ASSESSMENT AND CONSULTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:724-433-6555
Mailing Address - Street 1:6 MCMAHAN LN
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-4124
Mailing Address - Country:US
Mailing Address - Phone:724-433-6555
Mailing Address - Fax:
Practice Address - Street 1:805 S ALEXANDRIA ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1502
Practice Address - Country:US
Practice Address - Phone:724-879-4284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035723350001Medicaid