Evans, Clea C

Evans, Clea C is an individual health care provider with primary practice located at 1350 E Woodrow Wilson Ave , Jackson MS 39216-5112. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical Neuropsychologist, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical Neuropsychologist is her primary health care specialty. Evans, Clea C can be contacted via phone (601) 981-2611.

Contact Information

Primary practice address
1350 E Woodrow Wilson Ave Jackson MS 39216-5112
Phone: (601) 981-2611
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X 41-679 Mississippi
Behavioral Health & Social Service Providers / Clinical 103TC0700X 41-679 Mississippi

Profile Details

NPI number 1942359096
LBN Legal business name Evans, Clea C
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 9th, 2007
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942359096 NPPES
Mississippi MEDICAID 01355624

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