Jacob Russell Evans
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Nampa, ID
NPI 1902780331 · NPPES record last updated Jul 31, 2025
Key facts
- NPI
- 1902780331
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 5120 (ID)
- Practice address
- 58 N Granite Falls Dr
Nampa, ID 83651-5198 - Phone
- (304) 839-5448
- NPI assigned
- Jul 31, 2025
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5120 | ID | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 5120 | ID | Yes |
Addresses
Primary practice location
58 N Granite Falls Dr
Nampa, ID 83651-5198
Mailing address
58 N Granite Falls Dr
Nampa, ID 83651-5198
Phone (304) 839-5448
Other providers in Nampa, ID
- Paul Espinoza
- Thomas Whitney Essig
- Vanesa Marie Estrada
- Arthur L Evans
- Jaclyn Evans
- Laurel Evans
- Mark Evans
- Davis Jordon Everton
- Everything Cpap, LLC
- Evolving Minds Mental Health
All providers in Nampa, ID · Addiction (Substance Use Disorder) Counselor in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.