Provider Demographics
NPI:1568484715
Name:EVANS, KATHLEEN BERRY (MA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BERRY
Last Name:EVANS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4470 NW 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34475-7240
Mailing Address - Country:US
Mailing Address - Phone:352-351-6968
Mailing Address - Fax:352-351-6991
Practice Address - Street 1:4470 NW 22ND AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-7240
Practice Address - Country:US
Practice Address - Phone:352-351-6968
Practice Address - Fax:352-351-6991
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health