Samantha Marcinette Evans, MS, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CC02579 Issued in MN

Practice address

4225 Technology Dr NW
Bemidji, MN 56601-5118

Phone

(218) 751-0281

Fax

(218) 751-0870

NPI assigned

Sep 22, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600732800000",
    "number": "1326654617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 SE 1ST ST",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443681",
            "telephone_number": "218-380-7310",
            "fax_number": "218-999-7068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4225 TECHNOLOGY DR NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015118",
            "telephone_number": "218-751-0281",
            "fax_number": "218-751-0870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "SAMANTHA",
        "middle_name": "MARCINETTE",
        "credential": "MS, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-22",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "CC02579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arlon Bruce Eriksson, CRNA
• Matthew John Eriksson, APRN, CRNA
• Naomi Dawn Erle Thomas, CHW, LADC
• Edgar Lee Espe, DPM
• Erica Evans, LDA, CDA, CHW
• Wendy Marie Evans
• Evergreen Youth and Family Services, Inc
• Explore Chiropractic
• Face It Together Bemidji
• Mary E Fairbanks, MS, RN, PHN

• Mental Health Counselor in Bemidji, MN
• Providers in Bemidji, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.