Healthcare Provider Details

I. General information

NPI: 1477465722
Provider Name (Legal Business Name): DAVID JEREMIAH EVANS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 SW FIR LOOP STE 110
TIGARD OR
97223-8094
US

IV. Provider business mailing address

19448 STILLMEADOW DR
OREGON CITY OR
97045-8941
US

V. Phone/Fax

Practice location:
  • Phone: 971-202-0552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: