Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 2217 | TX |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 7252 | PA |
N | 101YP1600X | Pastoral Counselor | ||
N | 101YP2500X | Professional Counselor | 10310 | TX |
Y | 101YP2500X | Professional Counselor | PC002386 | PA |
N | 104100000X | Social Worker | 23423 | TX |
NPI | 1275644056 |
---|---|
Provider Name | Mr. Timothy Craig Evans |
First Address | State College, PA 16803-1450 |
Second Address | State College, PA 16801-2627 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2052LC | BCBS PROVIDER # (01) | TX |
82600L | BCBS PROVIDER # (01) | TX |
8Z1238 | BCBS PROVIDER # (01) | TX |