Provider Demographics
NPI:1609023605
Name:EVNAS, MARTHA ANNE (BA)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANNE
Last Name:EVNAS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:M
Other - Middle Name:ANNE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:PO BOX 1404
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74502-1404
Mailing Address - Country:US
Mailing Address - Phone:918-423-6030
Mailing Address - Fax:918-423-2370
Practice Address - Street 1:108 S WITTE ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4208
Practice Address - Country:US
Practice Address - Phone:918-647-3546
Practice Address - Fax:918-647-4003
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)