Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 351 | NE |
NPI | 1235212432 |
---|---|
Provider Name | Joseph Evans |
First Address | Omaha, NE 68198-5450 |
Second Address | Omaha, NE 68198-5450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025287200 | (05) | NE |
S58100 | (02) | NE |