Provider Demographics
NPI:1972059947
Name:EVANS, KATIE (LCAC, LCMFT)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCAC, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 ASH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1925
Mailing Address - Country:US
Mailing Address - Phone:913-648-6940
Mailing Address - Fax:877-329-8382
Practice Address - Street 1:11100 ASH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1925
Practice Address - Country:US
Practice Address - Phone:913-648-6940
Practice Address - Fax:877-329-8382
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS446OCAC101YA0400X
KS693106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist