Provider Demographics
NPI:1578941332
Name:EVANS, RICHARD PATRICK JR (CSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:PATRICK
Last Name:EVANS
Suffix:JR
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-4131
Mailing Address - Country:US
Mailing Address - Phone:801-621-1901
Mailing Address - Fax:
Practice Address - Street 1:3505 GRANT AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-4131
Practice Address - Country:US
Practice Address - Phone:801-621-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10509933-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT260022408OtherRAILROAD MEDICARE
UT876000308007Medicaid
UT876000308007Medicaid