Provider Demographics
NPI:1336802503
Name:HOOVER, EVAN B
Entity Type:Individual
Prefix:MRS
First Name:EVAN
Middle Name:B
Last Name:HOOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVAN
Other - Middle Name:BREE
Other - Last Name:YAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5560 NIAGARA DR
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-4911
Mailing Address - Country:US
Mailing Address - Phone:814-270-7487
Mailing Address - Fax:
Practice Address - Street 1:5560 NIAGARA DR
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4911
Practice Address - Country:US
Practice Address - Phone:814-270-7487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LAPLC9197101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator