Provider Demographics
NPI:1740578160
Name:EVANS, MITCHEL (BS HUMAN SERVICES)
Entity Type:Individual
Prefix:
First Name:MITCHEL
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:BS HUMAN SERVICES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 N RAINBOW BLVD APT 1035
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-5759
Mailing Address - Country:US
Mailing Address - Phone:702-882-9359
Mailing Address - Fax:
Practice Address - Street 1:4650 N RAINBOW BLVD APT 1035
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-5759
Practice Address - Country:US
Practice Address - Phone:702-882-9359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor