Provider Demographics
NPI:1154600245
Name:EVANS, JOSHUA AARON (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:AARON
Last Name:EVANS
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 THUNDERSTICK DR.
Mailing Address - Street 2:SUITE 1104
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505
Mailing Address - Country:US
Mailing Address - Phone:859-254-1035
Mailing Address - Fax:913-621-5730
Practice Address - Street 1:2250 THUNDERSTICK DR.
Practice Address - Street 2:SUITE 1104
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505
Practice Address - Country:US
Practice Address - Phone:859-254-1035
Practice Address - Fax:913-621-5730
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2547081041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100665780Medicaid