Provider Demographics
NPI:1942938469
Name:EVANS MARRIAGE FAMILY THERAPY INC.
Entity Type:Organization
Organization Name:EVANS MARRIAGE FAMILY THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:ELISABETH
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, MA
Authorized Official - Phone:818-426-4979
Mailing Address - Street 1:1615 S 2ND ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-3439
Mailing Address - Country:US
Mailing Address - Phone:818-426-4979
Mailing Address - Fax:
Practice Address - Street 1:1615 S 2ND ST UNIT 4
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-3439
Practice Address - Country:US
Practice Address - Phone:818-426-4979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty