Provider Demographics
NPI:1194889626
Name:EVANS, THOMAS FREDERICK (MFT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:FREDERICK
Last Name:EVANS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 VICTORIAN PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926
Mailing Address - Country:US
Mailing Address - Phone:530-343-0525
Mailing Address - Fax:
Practice Address - Street 1:7 GOVERNORS LN STE 11
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1990
Practice Address - Country:US
Practice Address - Phone:530-828-6868
Practice Address - Fax:530-892-2900
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT30754106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1194889626Medicaid