Provider Demographics
NPI:1194252007
Name:EVANS, CELINA PATRICE (BCBA)
Entity type:Individual
Prefix:
First Name:CELINA
Middle Name:PATRICE
Last Name:EVANS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-1124
Mailing Address - Country:US
Mailing Address - Phone:913-250-5634
Mailing Address - Fax:
Practice Address - Street 1:1719 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-1124
Practice Address - Country:US
Practice Address - Phone:913-850-5634
Practice Address - Fax:913-250-6561
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
KS103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty