Provider Demographics
NPI:1194470575
Name:EVANS, RICHARD WALLACE JR (CRC, LPCC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:WALLACE
Last Name:EVANS
Suffix:JR
Gender:M
Credentials:CRC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 W MCLAUGHLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-3024
Mailing Address - Country:US
Mailing Address - Phone:270-821-6426
Mailing Address - Fax:
Practice Address - Street 1:260 W MCLAUGHLIN AVE
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-3024
Practice Address - Country:US
Practice Address - Phone:270-821-6426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY296010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty