Provider Demographics
NPI:1194124180
Name:ENGLE, EVAN
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:ENGLE
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 1:2484 N STOKESBERRY PL STE 150
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6084
Mailing Address - Country:US
Mailing Address - Phone:720-663-0288
Mailing Address - Fax:
Practice Address - Street 1:2484 N STOKESBERRY PL STE 150
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6084
Practice Address - Country:US
Practice Address - Phone:720-663-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC-0015208101YM0800X
101YM0800X
IDLCPC-8643101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health