Provider Demographics
NPI:1427416445
Name:EVANS, COLLEEN (LMFT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMFT
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 351
Mailing Address - Street 2:
Mailing Address - City:CONVOY
Mailing Address - State:OH
Mailing Address - Zip Code:45832-0351
Mailing Address - Country:US
Mailing Address - Phone:719-510-7056
Mailing Address - Fax:614-656-6614
Practice Address - Street 1:3204 N ACADEMY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5163
Practice Address - Country:US
Practice Address - Phone:719-510-7056
Practice Address - Fax:614-656-6614
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2598106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist