Provider Demographics
NPI:1972031649
Name:EVANS, TERRY J (CATC E1009011556)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:J
Last Name:EVANS
Suffix:
Gender:F
Credentials:CATC E1009011556
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-1051
Mailing Address - Country:US
Mailing Address - Phone:661-861-6111
Mailing Address - Fax:661-861-6161
Practice Address - Street 1:1845 S COURT ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-5423
Practice Address - Country:US
Practice Address - Phone:559-733-5550
Practice Address - Fax:559-733-5550
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAE1009011556101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)