Provider Demographics
NPI:1922387653
Name:EVANS-WILCOX, ALBUS DIMABO (MFT)
Entity Type:Individual
Prefix:
First Name:ALBUS
Middle Name:DIMABO
Last Name:EVANS-WILCOX
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13009 PEREGRINE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5426
Mailing Address - Country:US
Mailing Address - Phone:405-703-0622
Mailing Address - Fax:405-703-0622
Practice Address - Street 1:6701 BROADWAY EXT STE 210
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-8213
Practice Address - Country:US
Practice Address - Phone:405-242-2242
Practice Address - Fax:405-286-1730
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health