Individual
DERRICK EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2577 NE COURTNEY DR, BEND, OR 97701-7752
(541) 322-7500
(541) 322-7565
Mailing address
2577 NE COURTNEY DR, BEND, OR 97701-7752
(541) 322-7500
(541) 322-7565
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
175T00000X
Peer Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101YA0400X
—
OR
Enumeration date
02/01/2016
Last updated
09/09/2021
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