Basic Information
| Provider Information | |||||||||
| NPI: | 1164636601 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | EILEEN | ||||||||
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| Credential: | L.C.P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 EDWARD ST. | ||||||||
| Address2: | |||||||||
| City: | PIERRON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622730587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186546946 | ||||||||
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| Practice Location | |||||||||
| Address1: | 421 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | VANDALIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624712214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182834229 | ||||||||
| FaxNumber: | 6182839302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.