Provider Demographics
NPI:1215452453
Name:EVANS, TODD CHRISTIAN (EDS, MA, MED)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:CHRISTIAN
Last Name:EVANS
Suffix:
Gender:M
Credentials:EDS, MA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 S WOODS AVE
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60051-8077
Mailing Address - Country:US
Mailing Address - Phone:847-254-8690
Mailing Address - Fax:
Practice Address - Street 1:3218 S WOODS AVE
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60051-8077
Practice Address - Country:US
Practice Address - Phone:847-254-8690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1815116103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool