1881878890 NPI number — DR. NAN EVANS MFT PHD CLINICAL PSY

Table of content: DR. NAN EVANS MFT PHD CLINICAL PSY (NPI 1881878890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881878890 NPI number — DR. NAN EVANS MFT PHD CLINICAL PSY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANS
Provider First Name:
NAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MFT PHD CLINICAL PSY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIS
Provider Other First Name:
NAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881878890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2730 GLENDESSARY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93105-2962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-682-9235
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2730 GLENDESSARY LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-682-9235
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2007

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: 106H00000X , with the licence number:  MX18134 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MX18134 . This is a "MARRIAGE & FAMILY THERAPIST LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".