Provider Demographics
NPI:1669994828
Name:EVANS, KRISTEN (MA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N TILLOTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-3988
Mailing Address - Country:US
Mailing Address - Phone:765-254-5184
Mailing Address - Fax:765-741-0335
Practice Address - Street 1:2010 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-4042
Practice Address - Country:US
Practice Address - Phone:765-393-0063
Practice Address - Fax:765-393-3761
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000412A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor