Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 1592 | MT |
Y | 101YP2500X | Professional Counselor | 1592 | MT |
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist |
NPI | 1003048299 |
---|---|
Provider Name | Dr. Crystal Rose Evans |
First Address | Browning, MT 59417-2255 |
Second Address | Browning, MT 59417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2009 |
Last Update Date | 18/07/2014 |