Provider Demographics
NPI:1508877358
Name:EVANS, KAREN A (PHD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6091 SINGLE TREE LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2423
Mailing Address - Country:US
Mailing Address - Phone:937-307-5949
Mailing Address - Fax:
Practice Address - Street 1:7061 CORPORATE WAY STE 210
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4273
Practice Address - Country:US
Practice Address - Phone:937-307-5949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5896103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2404633Medicaid
OH2404633Medicaid
OHP88265Medicare UPIN