Evans, Theresa A
Evans, Theresa A is an individual health care provider with primary practice located at 3130 Logan Valley Rd , Traverse City MI 49684-4772. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Evans, Theresa A can be contacted via phone (231) 409-8622.Contact Information
Primary practice address
3130 Logan Valley Rd
Traverse City MI 49684-4772
Phone: (231) 409-8622
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 6801066444 | Michigan |
Profile Details
| NPI number | 1972659845 |
|---|---|
| LBN Legal business name | Evans, Theresa A |
| Credentials | MSW, LMSW |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 25th, 2007 |
| Last updated | Sep 26th, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1972659845 | NPPES |
| Michigan | MEDICAID | 1972659845 |
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