Provider Demographics
NPI:1538500806
Name:ANDERSON, EVAN TYLER (M ED)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:TYLER
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N MONROE ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2104
Mailing Address - Country:US
Mailing Address - Phone:509-209-2728
Mailing Address - Fax:
Practice Address - Street 1:901 N MONROE ST
Practice Address - Street 2:STE 200
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2104
Practice Address - Country:US
Practice Address - Phone:509-209-2728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst