Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | IL |
NPI | 1003007667 |
---|---|
Provider Name | Ms. Kimberly Anne Evans |
First Address | Barrington, IL 60010-3036 |
Second Address | Barrington, IL 60010-3036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2007 |
Last Update Date | 07/08/2007 |