Provider Demographics
NPI:1932216314
Name:JONES-EVANS, SALLY S (MSW ACSW LMFT)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:S
Last Name:JONES-EVANS
Suffix:
Gender:F
Credentials:MSW ACSW LMFT
Other - Prefix:MS
Other - First Name:SALLY
Other - Middle Name:SORJ
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW ACSW LMFT
Mailing Address - Street 1:3010 E STATE BLVD
Mailing Address - Street 2:CENTER FOR NEUROBEHAVIORAL SERVICES
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805
Mailing Address - Country:US
Mailing Address - Phone:260-471-2300
Mailing Address - Fax:260-471-2778
Practice Address - Street 1:3010 E STATE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805
Practice Address - Country:US
Practice Address - Phone:260-471-2300
Practice Address - Fax:260-471-2778
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35000877A106H00000X
IN104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000309372OtherANTHEM