Basic Information
| Provider Information | |||||||||
| NPI: | 1619126869 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPCC, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 316 SAWYER DR | ||||||||
| Address2: | |||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813036560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707593878 | ||||||||
| FaxNumber: | 9702596605 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 NORTH RD | ||||||||
| Address2: | |||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813036430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707593878 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2008 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC.0012344 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | 0134831 | NM | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.