Individual
ANTONIO EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
406 TISDALE DR, BASTROP, LA 71220-3747
(189) 974-6000
Mailing address
406 TISDALE DR, BASTROP, LA 71220-3747
(189) 974-6000
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/16/2018
Last updated
12/07/2018
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