Individual
JACK MICHAEL EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, BCBA
Contact information
Practice address
125 S MAIN CROSS ST, LOUISA, KY 41230-1065
(606) 638-0938
Mailing address
321 E TIVERTON WAY, LEXINGTON, KY 40517-1529
(859) 983-1548
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-20-41236
—
103K00000X
Behavior Analyst
Primary
276596
KY
Other
Enumeration date
03/13/2022
Last updated
03/05/2024
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