Provider Demographics
NPI:1780660258
Name:EVANS, PATRICIA J (MA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:EVANS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:J
Other - Last Name:VANFLEET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:754 BAGNELL DAM BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-8703
Mailing Address - Country:US
Mailing Address - Phone:573-873-6014
Mailing Address - Fax:
Practice Address - Street 1:754 BAGNELL DAM BLVD STE F
Practice Address - Street 2:
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049-8703
Practice Address - Country:US
Practice Address - Phone:573-873-6014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003010307101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor