Provider Demographics
NPI:1396237327
Name:EVANS, JOSHUA (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 OLD CANTON RD STE 470
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4225
Mailing Address - Country:US
Mailing Address - Phone:504-484-9252
Mailing Address - Fax:
Practice Address - Street 1:3000 OLD CANTON RD STE 470
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4225
Practice Address - Country:US
Practice Address - Phone:504-484-9252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
MS2995101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist