Doctor Name: | MR. LANDON WALKER EVANS |
NPI Number: | 1558769976 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A. |
License Number: | OH3206459 |
Business Practice Address: | 130 Bonnieview Ave Minerva, OH - 446572014 |
Business Phone Number: | 3302050596 |
Business Fax Number: | |
Mailing Address: | 130 Bonnieview Ave, MINERVA |
State: | OH |
Postal Code: | 446572014 |
Phone Number: | 3302050596 |
Fax Number: | |
NPI Enumeration Date: | 12/17/2014 |
NPI Last Update Date: | 12/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | OH3206459 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |