Jack Michael Evans, MA, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

276596 Issued in KY

Practice address

125 S Main Cross St
Louisa, KY 41230-1065

Phone

(606) 638-0938

NPI assigned

Mar 13, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Evans Behavioral Consulting LLC

  • Behavior Analyst
  • Lexington, KY
  • NPI 1962269936
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1306594916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 E TIVERTON WAY",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405171529",
            "telephone_number": "859-983-1548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 S MAIN CROSS ST",
            "city": "LOUISA",
            "state": "KY",
            "postal_code": "412301065",
            "telephone_number": "606-638-0938"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1181 Highway 119 N",
            "address_purpose": "LOCATION",
            "city": "Whitesburg",
            "state": "KY",
            "postal_code": "418589473",
            "country_code": "US",
            "telephone_number": "859-983-1548",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EVANS",
        "first_name": "JACK",
        "middle_name": "MICHAEL",
        "credential": "MA, BCBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-13",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-20-41236",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "KY",
            "license": "276596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terry Brandon Emory
• Goldia Karen Endicott
• Stephanie A Endicott, PSS
• Weston Taylor Joseph Erp, PSS
• Ashley Brooke Evans
• Kevin Wayne Evans, PSS
• James Darren Eversole
• Kristy Lynn Eversole
• Stephen Faehr
• Connie Fairchild

• Behavior Analyst in Louisa, KY
• Providers in Louisa, KY by specialty
• Behavior Analyst in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.