Provider Demographics
NPI:1497177141
Name:EVANS, JODY PAMELA (MFT)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:PAMELA
Last Name:EVANS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1979 HATHAWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-5172
Mailing Address - Country:US
Mailing Address - Phone:818-802-8332
Mailing Address - Fax:
Practice Address - Street 1:1979 HATHAWAY AVE
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-5172
Practice Address - Country:US
Practice Address - Phone:818-802-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78397101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health