Provider Demographics
NPI:1134571102
Name:EVELAND, JEFFREY (LMHC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:EVELAND
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6143 COUNTY ROAD 41
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14425-8931
Mailing Address - Country:US
Mailing Address - Phone:315-406-0390
Mailing Address - Fax:
Practice Address - Street 1:7353 STATE ROUTE 96
Practice Address - Street 2:CEDAR HOLLOW SHOPPES, BLDG. #1
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9788
Practice Address - Country:US
Practice Address - Phone:315-406-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002649-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health