Provider Demographics
NPI:1477997401
Name:EVELYN, CARRIE ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ANN
Last Name:EVELYN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MC GREGOR
Mailing Address - State:TX
Mailing Address - Zip Code:76657-2306
Mailing Address - Country:US
Mailing Address - Phone:254-981-4644
Mailing Address - Fax:
Practice Address - Street 1:410 W 3RD ST
Practice Address - Street 2:
Practice Address - City:MC GREGOR
Practice Address - State:TX
Practice Address - Zip Code:76657-2306
Practice Address - Country:US
Practice Address - Phone:254-981-4644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-21
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67220101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional