Provider Demographics
NPI:1871874461
Name:EVANS, AMANDA JEAN (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:JEAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 S 5TH ST STE 394
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2459
Mailing Address - Country:US
Mailing Address - Phone:314-246-0761
Mailing Address - Fax:
Practice Address - Street 1:1360 S 5TH ST STE 394
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2459
Practice Address - Country:US
Practice Address - Phone:314-246-0761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO7820101YA0400X
MO2014027374101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health