Provider Demographics
NPI:1396074654
Name:EVANS POWIS, JENNIFER LORINE (LPC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LORINE
Last Name:EVANS POWIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-1700
Mailing Address - Country:US
Mailing Address - Phone:816-522-7728
Mailing Address - Fax:314-261-9074
Practice Address - Street 1:1830 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-1700
Practice Address - Country:US
Practice Address - Phone:816-522-7728
Practice Address - Fax:314-261-9074
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009035752101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1396074654Medicaid