Provider Demographics
NPI:1922517085
Name:EVANS, SHELLY (LCSW)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
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:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:TRASKWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72167-0053
Mailing Address - Country:US
Mailing Address - Phone:501-467-6753
Mailing Address - Fax:
Practice Address - Street 1:11501 HURON LN
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1846
Practice Address - Country:US
Practice Address - Phone:866-951-4325
Practice Address - Fax:501-776-0411
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8947-C1041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator