Provider Demographics
NPI:1790841856
Name:EVANS, KRISTIN L (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E MENDENHALL ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3638
Mailing Address - Country:US
Mailing Address - Phone:406-922-0861
Mailing Address - Fax:
Practice Address - Street 1:214 E MENDENHALL ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3638
Practice Address - Country:US
Practice Address - Phone:406-922-0861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT645LCSW1041C0700X
TNLSW45811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0503319Medicaid
MT70815OtherBLUE CROSS