Provider Demographics
NPI:1003797986
Name:EVANOFF, MARK CONSTANTINE (PPS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:CONSTANTINE
Last Name:EVANOFF
Suffix:
Gender:M
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 W LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-6221
Mailing Address - Country:US
Mailing Address - Phone:209-667-9047
Mailing Address - Fax:
Practice Address - Street 1:441 W LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-6221
Practice Address - Country:US
Practice Address - Phone:209-667-9047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140161190101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool