Provider Demographics
NPI:1649455619
Name:EVANS, MARI LYNN (LPC)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:LYNN
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 FARM TO MARKET RD. 597
Mailing Address - Street 2:
Mailing Address - City:ABERNATHY
Mailing Address - State:TX
Mailing Address - Zip Code:79311-0310
Mailing Address - Country:US
Mailing Address - Phone:806-790-4742
Mailing Address - Fax:
Practice Address - Street 1:3417 FARM TO MARKET RD. 597
Practice Address - Street 2:
Practice Address - City:ABERNATHY
Practice Address - State:TX
Practice Address - Zip Code:79311-0310
Practice Address - Country:US
Practice Address - Phone:806-790-4742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional