Provider Demographics
NPI:1932469517
Name:EVANS, MINDY SUE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MINDY
Middle Name:SUE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:MINDY
Other - Middle Name:SUE
Other - Last Name:ABENDROTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1301 BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-9739
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3800 HERITAGE AVE STE A2
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2871
Practice Address - Country:US
Practice Address - Phone:517-643-4727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010785061041C0700X
MI1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool