Provider Demographics
NPI:1962540815
Name:EVANS, JANINE RENEE (LPC)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:RENEE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W MYRTLE ST
Mailing Address - Street 2:SUITE 224
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-4400
Mailing Address - Country:US
Mailing Address - Phone:979-848-6760
Mailing Address - Fax:
Practice Address - Street 1:104 W MYRTLE ST
Practice Address - Street 2:SUITE 224
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-4400
Practice Address - Country:US
Practice Address - Phone:979-848-6760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14082101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84643LOtherBLUE CROSS BLUE SHEILD