Provider Demographics
NPI:1962220780
Name:EVANS, ANNE HAUNSCHILD (LMFT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:HAUNSCHILD
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 1:20 AVENUE PORTOLA UNIT 423
Mailing Address - Street 2:
Mailing Address - City:EL GRANADA
Mailing Address - State:CA
Mailing Address - Zip Code:94018-8804
Mailing Address - Country:US
Mailing Address - Phone:650-223-5756
Mailing Address - Fax:
Practice Address - Street 1:851 FREMONT AVE STE 99
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5602
Practice Address - Country:US
Practice Address - Phone:650-223-5756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148915106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist