Provider Demographics
NPI:1558936179
Name:EVANS, ALEXANDRA G (MFTC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:G
Last Name:EVANS
Suffix:
Gender:F
Credentials:MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9233 PARK MEADOWS DR STE 121
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5698
Mailing Address - Country:US
Mailing Address - Phone:720-504-4329
Mailing Address - Fax:
Practice Address - Street 1:9233 PARK MEADOWS DR STE 121
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5698
Practice Address - Country:US
Practice Address - Phone:720-504-4329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014097106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist