Provider Demographics
NPI:1518144583
Name:EVANS, SHELBY (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:
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 1:8100 E 22ND ST N
Mailing Address - Street 2:STE 1600-B
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2388
Mailing Address - Country:US
Mailing Address - Phone:316-201-6462
Mailing Address - Fax:316-201-6428
Practice Address - Street 1:8100 E 22ND ST N
Practice Address - Street 2:STE 1600-B
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2388
Practice Address - Country:US
Practice Address - Phone:316-201-6462
Practice Address - Fax:316-201-6428
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1921103TC0700X, 103TC0700X
1073513103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst