Provider Demographics
NPI:1558579037
Name:DAILY, EVAN RAY (LMFT)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:RAY
Last Name:DAILY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 W BROADWAY PMB #333
Mailing Address - Street 2:SUITE E
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-9475
Mailing Address - Country:US
Mailing Address - Phone:307-732-3200
Mailing Address - Fax:
Practice Address - Street 1:PMB #333 970 WEST BROADWAY
Practice Address - Street 2:SUITE E
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-732-3230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY093106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist