Provider Demographics
NPI:1881878890
Name:EVANS, NAN (MFT PHD CLINICAL PSY)
Entity type:Individual
Prefix:DR
First Name:NAN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:MFT PHD CLINICAL PSY
Other - Prefix:
Other - First Name:NAN
Other - Middle Name:
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2730 GLENDESSARY LN
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-2962
Mailing Address - Country:US
Mailing Address - Phone:805-682-9235
Mailing Address - Fax:
Practice Address - Street 1:2730 GLENDESSARY LANE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105
Practice Address - Country:US
Practice Address - Phone:805-682-9235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMX18134106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMX18134OtherMARRIAGE & FAMILY THERAPIST LICENSE