Provider Demographics
NPI:1730795113
Name:EVANS, RENEE JESSICA
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:JESSICA
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8151 BIG SKY DR
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-4443
Mailing Address - Country:US
Mailing Address - Phone:916-533-1193
Mailing Address - Fax:
Practice Address - Street 1:105 E HILLIARD LN
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-3222
Practice Address - Country:US
Practice Address - Phone:541-780-8636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health