Provider Demographics
NPI:1861191132
Name:EVANS, SHAHNAAZ TYRESE (LCSW)
Entity type:Individual
Prefix:
First Name:SHAHNAAZ
Middle Name:TYRESE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850865
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-0865
Mailing Address - Country:US
Mailing Address - Phone:804-873-5142
Mailing Address - Fax:
Practice Address - Street 1:6224 CREEKHAVEN DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-4042
Practice Address - Country:US
Practice Address - Phone:804-873-5142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX631491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical