Individual
CODY RUDD EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
475 YELLOWSTONE AVE, STE E, POCATELLO, ID 83201-4528
(208) 232-0021
(208) 232-0031
Mailing address
1110 CALL CREEK DR., SUITE 7, POCATELLO, ID 83201-3072
(208) 233-2032
(208) 233-2175
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-4569
ID
101YM0800X
Mental Health Counselor
LPC4569
ID
Other
Enumeration date
08/04/2010
Last updated
06/15/2016
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