Provider Demographics
NPI:1689286395
Name:EVANS, MAYSON BREEANN
Entity Type:Individual
Prefix:
First Name:MAYSON
Middle Name:BREEANN
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 1:7107 S YALE AVE # 161
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6308
Mailing Address - Country:US
Mailing Address - Phone:918-280-0090
Mailing Address - Fax:918-561-6764
Practice Address - Street 1:7306 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7027
Practice Address - Country:US
Practice Address - Phone:918-280-0090
Practice Address - Fax:918-561-6764
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician