Provider Demographics
NPI:1184925661
Name:EVANS, ALLYSON (MS)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 NEAL ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4333
Mailing Address - Country:US
Mailing Address - Phone:931-525-6906
Mailing Address - Fax:931-525-6970
Practice Address - Street 1:1420 NEAL ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4333
Practice Address - Country:US
Practice Address - Phone:931-525-6906
Practice Address - Fax:931-525-6970
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health