Healthcare Provider Details

I. General information

NPI: 1124204029
Provider Name (Legal Business Name): JOSHUA JOEL EVANS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 NE IRVING ST STE 250
PORTLAND OR
97232-2265
US

IV. Provider business mailing address

1521 SUNFLOWER WAY
HUDSONVILLE MI
49426-8421
US

V. Phone/Fax

Practice location:
  • Phone: 503-233-4356
  • Fax:
Mailing address:
  • Phone: 231-350-1107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: