Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1124204029 |
---|---|
Provider Name | Joshua Joel Evans |
First Address | Hudsonville, MI 49426-8421 |
Second Address | Portland, OR 97232-2265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2008 |
Last Update Date | 20/02/2008 |