Provider Demographics
NPI:1730457052
Name:EVANS, MICHELLE LEA (LPC, NCC, CEDS-S)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEA
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPC, NCC, CEDS-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19046 E 51ST PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-8446
Mailing Address - Country:US
Mailing Address - Phone:314-882-5521
Mailing Address - Fax:
Practice Address - Street 1:3460 BRIARGATE BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4168
Practice Address - Country:US
Practice Address - Phone:719-578-5132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010041594101YM0800X
COLPC.0012914101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health