Provider Demographics
NPI:1932538519
Name:EVANS, VAN (MSW, PHD CANDIDATE)
Entity Type:Individual
Prefix:MR
First Name:VAN
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:MSW, PHD CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 E CASTO LN
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6302
Mailing Address - Country:US
Mailing Address - Phone:801-906-3107
Mailing Address - Fax:
Practice Address - Street 1:3970 S 700 E
Practice Address - Street 2:SUITE #17
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2191
Practice Address - Country:US
Practice Address - Phone:801-906-3107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6634597-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical