Organization
EVANS PSYCHOLOGICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY C EVANS PHD (OWNER)
(402) 330-1537
Entity
Organization
Contact information
Practice address
12728 AUGUSTA AVE, STE 150, OMAHA, NE 68144-3754
(402) 330-1537
(402) 330-9331
Mailing address
12728 AUGUSTA AVE, STE 150, OMAHA, NE 68144-3754
(402) 330-1537
(402) 330-9331
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
77
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47078906000
—
NE
Enumeration date
11/19/2007
Last updated
11/19/2007
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