| Doctor Name: | KELLEY F EVERSON |
| NPI Number: | 1053685602 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 4673-125 |
| Business Practice Address: | 17 S River St 254 Janesville, WI - 535483860 |
| Business Phone Number: | 6087555260 |
| Business Fax Number: | 6087555267 |
| Mailing Address: | 17 S River St, 254 JANESVILLE |
| State: | WI |
| Postal Code: | 535483860 |
| Phone Number: | 6087555260 |
| Fax Number: | 6087555267 |
| NPI Enumeration Date: | 02/29/2012 |
| NPI Last Update Date: | 02/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 4673-125 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |