Provider Demographics
NPI:1518590132
Name:EVANS, KATHRYN SULLIVAN (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SULLIVAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8126 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-2600
Mailing Address - Country:US
Mailing Address - Phone:317-403-5124
Mailing Address - Fax:
Practice Address - Street 1:8126 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-2600
Practice Address - Country:US
Practice Address - Phone:317-403-5124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008780A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor