Provider Demographics
NPI:1104060623
Name:EVANS, JENNIFER A (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
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 1:1000 LOCUST ST
Mailing Address - Street 2:MENTAL HEALTH SERVICE (116)
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2597
Mailing Address - Country:US
Mailing Address - Phone:888-838-6256
Mailing Address - Fax:775-328-1858
Practice Address - Street 1:1000 LOCUST ST
Practice Address - Street 2:MENTAL HEALTH SERVICE (116)
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2597
Practice Address - Country:US
Practice Address - Phone:888-838-6256
Practice Address - Fax:775-328-1858
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPSY0578103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical