Provider Demographics
NPI:1366559312
Name:EVANS, D BRENT (LCSW)
Entity type:Individual
Prefix:MR
First Name:D
Middle Name:BRENT
Last Name:EVANS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8607 WURZBACH RD BLDG V
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1303
Mailing Address - Country:US
Mailing Address - Phone:210-699-9290
Mailing Address - Fax:210-699-9282
Practice Address - Street 1:8607 WURZBACH RD BLDG V
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1294
Practice Address - Country:US
Practice Address - Phone:210-699-9290
Practice Address - Fax:210-699-9282
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA997786OtherVALUE OPTIONS
TX2619440OtherAETNA
TX743019457001OtherCIGNA
TX00S02DOtherBLUE CROSS BLUE SHIELD
TX371OtherLICENSE