Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | RC000512 | WA |
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003096983 |
---|---|
Provider Name | Mr. Richard J Evans V |
First Address | Bellingham, WA 98229-2638 |
Second Address | Bellingham, WA 98225-5236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2007 |
Last Update Date | 05/01/2021 |