Provider Demographics
NPI:1679056956
Name:EVANS, RACHEL (PMHP, PMSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:PMHP, PMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-3101
Mailing Address - Country:US
Mailing Address - Phone:531-299-7362
Mailing Address - Fax:
Practice Address - Street 1:2906 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-3101
Practice Address - Country:US
Practice Address - Phone:531-299-7362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE72661041S0200X
NE115801041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool