MEDICARE: JARVIS JAMELL EVANS

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	103TM1800X	Intellectual & Developmental Disabilities Psychologist	F70-F79	OH

General Provider Information

NPI Number	:	1225985153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARVIS JAMELL EVANS

Provider Business Mailing Address
First Line	:	10614 LANGTON AVE
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-2242
Country	:	US
Telephone Number	:	216-392-9369
Fax Number	:

Provider Business Practice Location Address
First Line	:	10614 LANGTON AVE
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-2242
Country	:	US
Telephone Number	:	216-392-9369
Fax Number	:

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

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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