Individual provider Active NPI

Isaac Daniel Evans

  • Professional Counselor
  • Cookeville, TN
National Provider Identifier
1386216802
Registry record updated Jul 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
5107 Issued in TN
Practice address
570 E 10TH St
Cookeville, TN 38501-1876
Phone
(931) 372-7117
NPI assigned
Jul 14, 2021
Last updated
Jul 14, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 5107 TN Primary

Addresses

Primary practice location

570 E 10TH St
Cookeville, TN 38501-1876

Mailing address

1306 Byrne Ave Apt 2
Cookeville, TN 38501-5123
Phone (615) 498-8018

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240319000956 TN Practitioner - Mental Health Counselor 1456798065 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Possibilities Counseling Professional CurrentSince Feb 22, 2024 Accepting new patients
Life Reimagined LLC CurrentSince Feb 22, 2024 Accepting new patients

Locations

570 E 10th St
Cookeville, TN 38501
Phone (931) 372-7117

3380 Walnut Grove Rd
Sparta, TN 38583
Phone (931) 345-3968

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1626220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626220800000",
    "number": "1386216802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 BYRNE AVE APT 2",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385015123",
            "telephone_number": "615-498-8018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 E 10TH ST",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385011876",
            "telephone_number": "931-372-7117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "ISAAC",
        "middle_name": "DANIEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-14",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TN",
            "license": "5107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cookeville, TN

Sources for this page

Verify at the official NPI Registry.