Provider Demographics
NPI:1669724316
Name:GIUDICE, EVAN (LMFT, CADC)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:GIUDICE
Suffix:
Gender:
Credentials:LMFT, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 NW CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-3112
Mailing Address - Country:US
Mailing Address - Phone:541-219-1390
Mailing Address - Fax:
Practice Address - Street 1:1135 NW CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-3112
Practice Address - Country:US
Practice Address - Phone:541-219-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X
CA69067106H00000X
ORT0982106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5000691476Medicaid