Provider Demographics
NPI:1346574142
Name:EVANS, THOMAS MICHAEL II
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:EVANS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35590 CENTER RIDGE RD
Mailing Address - Street 2:102
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-6000
Mailing Address - Country:US
Mailing Address - Phone:440-327-2388
Mailing Address - Fax:
Practice Address - Street 1:35590 CENTER RIDGE RD
Practice Address - Street 2:102
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-6000
Practice Address - Country:US
Practice Address - Phone:440-327-2388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5051103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic