Provider Demographics
NPI:1801160643
Name:EVENSEN, AMY (MA)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:EVENSEN
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 1:194 GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2625
Mailing Address - Country:US
Mailing Address - Phone:509-525-2799
Mailing Address - Fax:
Practice Address - Street 1:1520 KELLEY PL FL 2
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-8654
Practice Address - Country:US
Practice Address - Phone:509-525-2799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health