Provider Demographics
NPI:1679868186
Name:EVANS, KARIN FRIEDRICH
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:FRIEDRICH
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29614 E HARRIS POTTS RD
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-9591
Mailing Address - Country:US
Mailing Address - Phone:816-228-5633
Mailing Address - Fax:
Practice Address - Street 1:29614 E HARRIS POTTS RD
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-9591
Practice Address - Country:US
Practice Address - Phone:816-228-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002784101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional