Active NPI
Theresa Evanoff, MS
- Psychologist
- Morgantown, WV
National Provider Identifier
1891325361
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1244
- Practice address
- 418 Cobun Creek Rd
Morgantown, WV 26508-3832 - Phone
- (304) 614-4323
- NPI assigned
- Jan 23, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1244 | WV | |
| Psychologist | 103T00000X | 1244 | WV | Primary |
Addresses
Primary practice location
418 Cobun Creek Rd
Morgantown, WV 26508-3832
Mailing address
418 Cobun Creek Rd
Morgantown, WV 26508-3832
Phone (304) 614-4323
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1244 | WV | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727308800000",
"number": "1891325361",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "418 COBUN CREEK RD",
"city": "MORGANTOWN",
"state": "WV",
"postal_code": "265083832",
"telephone_number": "304-614-4323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "418 COBUN CREEK RD",
"city": "MORGANTOWN",
"state": "WV",
"postal_code": "265083832",
"telephone_number": "304-614-4323"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANOFF",
"first_name": "THERESA",
"credential": "MS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-23",
"last_updated": "2024-09-26",
"certification_date": "2024-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WV",
"license": "1244",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WV",
"license": "1244",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Morgantown, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.