Provider Demographics
NPI:1205557352
Name:EVANS, KATELIN SCOTT (LPC)
Entity type:Individual
Prefix:
First Name:KATELIN
Middle Name:SCOTT
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1066 YELLOWSTONE AVE APT 67
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4430
Mailing Address - Country:US
Mailing Address - Phone:208-547-7680
Mailing Address - Fax:
Practice Address - Street 1:110 S 19TH AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3312
Practice Address - Country:US
Practice Address - Phone:208-234-4722
Practice Address - Fax:208-234-2135
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-8921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health