Provider Demographics
NPI:1790196483
Name:EVANS, VICKI LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:VICKI
Other - Middle Name:LYNN
Other - Last Name:ABENDSCHEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4910 AIRPORT AVE
Mailing Address - Street 2:BUILDING A
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-5759
Mailing Address - Country:US
Mailing Address - Phone:281-239-1388
Mailing Address - Fax:281-232-2541
Practice Address - Street 1:4910 AIRPORT AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-5759
Practice Address - Country:US
Practice Address - Phone:281-239-1388
Practice Address - Fax:281-232-2541
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67737101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional