Provider Demographics
NPI:1104275734
Name:THOMAS, EVAN FRANK
Entity type:Individual
Prefix:MR
First Name:EVAN
Middle Name:FRANK
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CENTRAL AVE
Mailing Address - Street 2:SUITE E1
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-2740
Mailing Address - Country:US
Mailing Address - Phone:951-471-1426
Mailing Address - Fax:951-471-1453
Practice Address - Street 1:600 CENTRAL AVE
Practice Address - Street 2:SUITE E1
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-2740
Practice Address - Country:US
Practice Address - Phone:951-471-1426
Practice Address - Fax:951-471-1453
Is Sole Proprietor?:No
Enumeration Date:2016-06-04
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1185501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical