1770606972 NPI number — MR. ROBERT MARK EVANS LCSW, ACSW

Table of content: MR. ROBERT MARK EVANS LCSW, ACSW (NPI 1770606972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770606972 NPI number — MR. ROBERT MARK EVANS LCSW, ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANS
Provider First Name:
ROBERT
Provider Middle Name:
MARK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, ACSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EVANS
Provider Other First Name:
MARK
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW, ACSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1770606972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 MONTROSE BLVD
Provider Second Line Business Mailing Address:
UNIT 1103
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77006-4658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-447-2656
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1155 PRESSLER ST
Provider Second Line Business Practice Location Address:
UT MD ANDERSON CANCER PREVENTION BLDG UNIT 1330
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-3721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-792-5927
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2007

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: 1041C0700X , with the licence number:  19475 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: R0413121 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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