Provider Demographics
NPI:1194754010
Name:POLLOCK-EVANS, ARLETT J (MS, RN, CNS, CTP)
Entity type:Individual
Prefix:
First Name:ARLETT
Middle Name:J
Last Name:POLLOCK-EVANS
Suffix:
Gender:F
Credentials:MS, RN, CNS, CTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 341
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-0341
Mailing Address - Country:US
Mailing Address - Phone:937-592-9545
Mailing Address - Fax:937-592-9790
Practice Address - Street 1:2653 W ELM ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2506
Practice Address - Country:US
Practice Address - Phone:937-592-9545
Practice Address - Fax:937-592-9790
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03834100OtherMAGELLAN
OH00000038225OtherANTHEM
OH00000038225OtherANTHEM
OHPONS01465Medicare ID - Type UnspecifiedMEDICARE
OHX72088Medicare UPIN