Provider Demographics
NPI:1932176872
Name:EVANS, BRADLEY B SR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:B
Last Name:EVANS
Suffix:SR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5644 MARSHALL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-8104
Mailing Address - Country:US
Mailing Address - Phone:719-337-2529
Mailing Address - Fax:
Practice Address - Street 1:3800 S W S YOUNG DR STE 407
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3374
Practice Address - Country:US
Practice Address - Phone:254-252-3748
Practice Address - Fax:254-549-0086
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33721103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33721OtherLICENSE
CO3235OtherLICENSE