Provider Demographics
NPI:1457120156
Name:GIMPEL, EVAN SCOTT (LCPC)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:SCOTT
Last Name:GIMPEL
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2480
Mailing Address - Country:US
Mailing Address - Phone:336-202-0458
Mailing Address - Fax:
Practice Address - Street 1:316 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2480
Practice Address - Country:US
Practice Address - Phone:336-202-0458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT23435101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health