Provider Demographics
NPI:1720312614
Name:EVANS, ANTHONY L (BA PSYCHOLOGY)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:L
Last Name:EVANS
Suffix:
Gender:M
Credentials:BA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 S TELSHOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4889
Mailing Address - Country:US
Mailing Address - Phone:575-556-8478
Mailing Address - Fax:
Practice Address - Street 1:1690 S TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4889
Practice Address - Country:US
Practice Address - Phone:575-556-8478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator