1154677813 NPI number — MR. ADAM MARSHALL EVANS PSY.D.

Table of content: MR. ADAM MARSHALL EVANS PSY.D. (NPI 1154677813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154677813 NPI number — MR. ADAM MARSHALL EVANS PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANS
Provider First Name:
ADAM
Provider Middle Name:
MARSHALL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154677813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1172 W. GALBRAITH ROAD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
CIN.
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45231-5643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-549-0724
Provider Business Mailing Address Fax Number:
513-521-1333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1172 W. GALBRAITH RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45231-5643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-549-0724
Provider Business Practice Location Address Fax Number:
513-521-1333
Provider Enumeration Date:
07/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  6915 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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