MEDICARE: MICHELLE JEANETTE EVELAND MSW, LICSW, CMHS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	SC60443410	WA
2	1041C0700X	Clinical Social Worker	LW60904652	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073057865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE JEANETTE EVELAND MSW, LICSW, CMHS

Provider Business Mailing Address
First Line	:	1312 N MONROE ST # 115
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-2623
Country	:	US
Telephone Number	:	509-329-8413
Fax Number	:

Provider Business Practice Location Address
First Line	:	1312 N MONROE ST # 115
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-2623
Country	:	US
Telephone Number	:	509-329-8413
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2016
Last Update Date	:	05/28/2026

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