Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 6457 | CO |
N | 101YM0800X | Mental Health Counselor | 3092 | CO |
NPI | 1003010711 |
---|---|
Provider Name | Lisa Marie Evanich |
First Address | Grand Junction, CO 81501-4759 |
Second Address | Grand Junction, CO 81501-4759 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 08/07/2007 |