Provider Demographics
NPI:1174566327
Name:EVANS, MARILYNN MURPHY (PHD)
Entity type:Individual
Prefix:DR
First Name:MARILYNN
Middle Name:MURPHY
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PANDALE
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1738
Mailing Address - Country:US
Mailing Address - Phone:949-588-7070
Mailing Address - Fax:949-588-9696
Practice Address - Street 1:23591 EL TORO RD
Practice Address - Street 2:SUITE 204
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4774
Practice Address - Country:US
Practice Address - Phone:959-887-3470
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9303103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical