Provider Demographics
NPI:1306664982
Name:EVANS, JOHN DOUGLAS JR (BS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DOUGLAS
Last Name:EVANS
Suffix:JR
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2747 N REDDA RD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93737-9619
Mailing Address - Country:US
Mailing Address - Phone:323-901-0572
Mailing Address - Fax:
Practice Address - Street 1:2747 N REDDA RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93737-9619
Practice Address - Country:US
Practice Address - Phone:559-375-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health