Provider Demographics
NPI:1932286598
Name:EVANS, EARLENE M (LCSW)
Entity Type:Individual
Prefix:
First Name:EARLENE
Middle Name:M
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 35409
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5409
Mailing Address - Country:US
Mailing Address - Phone:702-656-6893
Mailing Address - Fax:702-248-2008
Practice Address - Street 1:1885 VILLAGE CENTER CIR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-6369
Practice Address - Country:US
Practice Address - Phone:702-656-6893
Practice Address - Fax:702-248-2008
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV02442C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV34347Medicare ID - Type Unspecified