Provider Demographics
NPI:1295035905
Name:EVANS, JENNIFER ANNE (LMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 N HOLLYWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2527
Mailing Address - Country:US
Mailing Address - Phone:818-429-7854
Mailing Address - Fax:818-301-7479
Practice Address - Street 1:1108 N HOLLYWOOD WAY
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2527
Practice Address - Country:US
Practice Address - Phone:818-429-7854
Practice Address - Fax:818-301-7479
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMFT 61713101YM0800X
CALMFT81067106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health