Basic Information
| Provider Information | |||||||||
| NPI: | 1194005306 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | EVELYN | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | LSCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1832 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667621832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202319873 | ||||||||
| FaxNumber: | 6202315062 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 W 8TH ST | ||||||||
| Address2: | |||||||||
| City: | COFFEYVILLE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 673374109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202514300 | ||||||||
| FaxNumber: | 6202514979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2011 | ||||||||
| LastUpdateDate: | 12/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 4128 | KS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LMSW5111 | KS | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.