Provider Demographics
NPI:1508324161
Name:EVANS, ALISA (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:ALISA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 S 700 E STE 9
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2581
Mailing Address - Country:US
Mailing Address - Phone:801-680-2343
Mailing Address - Fax:801-639-9544
Practice Address - Street 1:4020 S 700 E STE 2
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2577
Practice Address - Country:US
Practice Address - Phone:801-930-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-03
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT328353-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health