Provider Demographics
NPI:1912214073
Name:EVANS, DANA JACQUELINE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:JACQUELINE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 FORREST CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-7598
Mailing Address - Country:US
Mailing Address - Phone:208-404-3715
Mailing Address - Fax:
Practice Address - Street 1:7424 APENNINES DR
Practice Address - Street 2:
Practice Address - City:FT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-7151
Practice Address - Country:US
Practice Address - Phone:785-240-2716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4405101YM0800X
IDLCPC 4918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health