Provider Demographics
NPI:1740640275
Name:DART, EVAN HENRY (PHD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:HENRY
Last Name:DART
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ROBINS NEST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-9098
Mailing Address - Country:US
Mailing Address - Phone:985-373-1497
Mailing Address - Fax:
Practice Address - Street 1:33 ROBINS NEST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-9098
Practice Address - Country:US
Practice Address - Phone:985-373-1497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS55978103T00000X
MS160025103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst