Provider Demographics
NPI:1578620324
Name:EVANS, CC KENEE (MA MFT)
Entity Type:Individual
Prefix:MS
First Name:CC
Middle Name:KENEE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14150 CULVER DR
Mailing Address - Street 2:STE 203
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604
Mailing Address - Country:US
Mailing Address - Phone:714-697-4697
Mailing Address - Fax:949-552-0396
Practice Address - Street 1:14150 CULVER DR
Practice Address - Street 2:STE 203
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604
Practice Address - Country:US
Practice Address - Phone:714-697-4697
Practice Address - Fax:949-552-0396
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39910106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist