Active NPI
Jennifer Lynn Evans, PSY.D.
- Clinical Psychologist
- Saint Charles, MO
National Provider Identifier
1689993164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2002011125
- Practice address
- 2451 Executive Dr
Suite 103
Saint Charles, MO 63303-5606 - Phone
- (636) 300-9922
- Fax
- (636) 300-9922
- NPI assigned
- May 24, 2010
- Last updated
- May 28, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2002011125 | MO | Primary |
Addresses
Primary practice location
2451 Executive Dr
Suite 103
Saint Charles, MO 63303-5606
Mailing address
2451 Executive Dr
Suite 103
Saint Charles, MO 63303-5606
Phone (636) 300-9922
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2002011125 | MO | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riversedge Psychological Services | Clinical | Current | Accepting new patients |
| Susic Psychological Consulting, PC | Clinical | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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dba Senior Care Psychological Consulting
- Clinical Psychologist
- Saint Charles, MO
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1275004800000",
"number": "1689993164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2451 EXECUTIVE DR",
"address_2": "SUITE 103",
"city": "SAINT CHARLES",
"state": "MO",
"postal_code": "633035606",
"telephone_number": "636-300-9922",
"fax_number": "636-300-9922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2451 EXECUTIVE DR",
"address_2": "SUITE 103",
"city": "SAINT CHARLES",
"state": "MO",
"postal_code": "633035606",
"telephone_number": "636-300-9922",
"fax_number": "636-300-9922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "JENNIFER",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-05-24",
"last_updated": "2010-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MO",
"license": "2002011125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Charles, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.