Provider Demographics
NPI:1740080357
Name:EVANS, KULEA MONIQUE
Entity type:Individual
Prefix:MRS
First Name:KULEA
Middle Name:MONIQUE
Last Name:EVANS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 NE 63RD ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-5060
Mailing Address - Country:US
Mailing Address - Phone:913-575-3812
Mailing Address - Fax:
Practice Address - Street 1:4049 PENNSYLVANIA AVE STE 203
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3022
Practice Address - Country:US
Practice Address - Phone:913-575-3812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01277-P101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)