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CLEA C EVANS PHD

Clinical Neuropsychologist

Jackson, Mississippi

Provider NPI: 1942359096

Provider Information:
 CLEA C EVANS PHD
Gender: F
Not Sole Proprietor

Practice Location:
1350 E WOODROW WILSON AVE  JACKSON, MS 39216 US
Tel: 601-981-2611  Fax: --

Business Mailing Address:
1350 E WOODROW WILSON AVE  JACKSON, MS 39216 US
Tel: 601-981-2611  Fax: --

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
X103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
MS41-679
X103TC0700XBehavioral Health & Social Service Providers
Psychologist
MS41-679

Other Provider Identifiers:

IssuerNumberStateType
01355624MS05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







CLINICAL NEUROPSYCHOLOGIST JOBS MS - Page 1



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