Provider Demographics
NPI:1255988705
Name:EVANS, DARLA JO (PLPC)
Entity type:Individual
Prefix:
First Name:DARLA
Middle Name:JO
Last Name:EVANS
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:DARLA
Other - Middle Name:
Other - Last Name:COSTALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2832
Mailing Address - Country:US
Mailing Address - Phone:636-224-1210
Mailing Address - Fax:
Practice Address - Street 1:2411 W CATALPA ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-1123
Practice Address - Country:US
Practice Address - Phone:417-862-3455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019031919101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor