Provider Demographics
NPI:1700215811
Name:JOHNSON, EVAN (MPA)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 S 72ND ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-3013
Mailing Address - Country:US
Mailing Address - Phone:253-507-7231
Mailing Address - Fax:253-507-7690
Practice Address - Street 1:1315 S 72ND ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-3013
Practice Address - Country:US
Practice Address - Phone:253-507-7231
Practice Address - Fax:253-507-7690
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor