Provider Demographics
NPI:1073057865
Name:EVELAND, MICHELLE JEANETTE (MSW, LICSW, CMHS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JEANETTE
Last Name:EVELAND
Suffix:
Gender:F
Credentials:MSW, LICSW, CMHS
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:JEANETTE
Other - Last Name:SCULLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSWAIC
Mailing Address - Street 1:521 N ARGONNE RD
Mailing Address - Street 2:BUILDING B SUITE 105
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-2954
Mailing Address - Country:US
Mailing Address - Phone:509-329-8413
Mailing Address - Fax:
Practice Address - Street 1:521 N ARGONNE RD
Practice Address - Street 2:BUILDING B SUITE 105
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2954
Practice Address - Country:US
Practice Address - Phone:509-329-8413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW609046521041C0700X
WASC60443410101Y00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2114157Medicaid