Provider Demographics
NPI:1891445110
Name:EVANSTON, JEREMY (BA PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:EVANSTON
Suffix:
Gender:M
Credentials:BA PSYCHOLOGY
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2107 1ST ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-0840
Mailing Address - Country:US
Mailing Address - Phone:707-296-1865
Mailing Address - Fax:707-442-2058
Practice Address - Street 1:2107 1ST ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0840
Practice Address - Country:US
Practice Address - Phone:707-296-1865
Practice Address - Fax:707-442-2058
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)