Provider Demographics
NPI:1760673008
Name:EVANS, DONALD DOYLE (PHD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:DOYLE
Last Name:EVANS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1366
Mailing Address - Country:US
Mailing Address - Phone:515-251-8626
Mailing Address - Fax:
Practice Address - Street 1:1350 NW 138TH ST
Practice Address - Street 2:STE 200
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8377
Practice Address - Country:US
Practice Address - Phone:515-223-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical