Provider Demographics
NPI:1730628421
Name:MATHENEY, EVAN (LPCC)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:MATHENEY
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 E INNIS AVE UNIT 72187
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-6809
Mailing Address - Country:US
Mailing Address - Phone:614-515-7858
Mailing Address - Fax:
Practice Address - Street 1:445 E INNIS AVE UNIT 72187
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-6809
Practice Address - Country:US
Practice Address - Phone:614-515-7858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1901200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1473276Medicaid