Individual
JACOB RUSSELL EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
58 N GRANITE FALLS DR, NAMPA, ID 83651-5198
(304) 839-5448
Mailing address
58 N GRANITE FALLS DR, NAMPA, ID 83651-5198
(304) 839-5448
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
5120
ID
Other
Enumeration date
07/31/2025
Last updated
07/31/2025
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