Basic Information
Provider Information
NPI: 1316384910
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SPAAR
FirstName: EVELYN
MiddleName: M
NamePrefix: MS.
NameSuffix:  
Credential: MA, LMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3000 41ST STREET OCEAN
Address2:  
City: MARATHON
State: FL
PostalCode: 330502373
CountryCode: US
TelephoneNumber: 3054347660
FaxNumber: 3054349040
Practice Location
Address1: 3000 41ST STREET OCEAN
Address2: GUIDANCE CARE CENTER
City: MARATHON
State: FL
PostalCode: 330502373
CountryCode: US
TelephoneNumber: 3054347660
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/23/2013
LastUpdateDate: 02/01/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XMH12881FLY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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