Provider Demographics
NPI:1538611082
Name:EVANS, JAZMIN DARYN
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:DARYN
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAZMIN
Other - Middle Name:DARYN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPP
Mailing Address - Street 1:2113 THOMAS AVE APT D
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1317 17TH ST # 8
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-3555
Practice Address - Country:US
Practice Address - Phone:719-589-4505
Practice Address - Fax:719-589-4603
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health