Individual provider Active NPI

Amy Evans

  • Clinical Social Worker
  • Evansville, IN
National Provider Identifier
1952966046
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
629 Ingle St
Evansville, IN 47708-1345
Phone
(812) 602-4022
NPI assigned
May 5, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X
Clinical Social Worker 1041C0700X IN Primary

Addresses

Primary practice location

629 Ingle St
Evansville, IN 47708-1345

Mailing address

629 Ingle St
Evansville, IN 47708-1345
Phone (812) 602-4022

Other practice location 1

1010 S Weinbach Ave
Evansville, IN 47714-2934
Phone (812) 647-5142

Other practice location 2

819 W Franklin St
Evansville, IN 47710-1137
Phone (812) 602-4022

Other identifiers 1

IdentifierTypeStateIssuer
201403210AMedicaidIN

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

Practice roles

OrganizationSpecialtyStatusNew patients
Safe Haven LLC Addiction (Substance Use Disorder) Past Accepting new patients
Now Counseling Services, LLC Addiction (Substance Use Disorder) PastSince Apr 17, 2018 Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1557014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1952966046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 INGLE ST",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477081345",
            "telephone_number": "812-602-4022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 INGLE ST",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477081345",
            "telephone_number": "812-602-4022"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1010 S Weinbach Ave",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477142934",
            "country_code": "US",
            "telephone_number": "812-647-5142",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "819 W Franklin St",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477101137",
            "country_code": "US",
            "telephone_number": "812-602-4022",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EVANS",
        "first_name": "AMY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-05",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201403210A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.