Provider Demographics
NPI:1588912208
Name:KEATHLEY, EVELYN G (LPC)
Entity type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:G
Last Name:KEATHLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:G
Other - Last Name:BURGOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:122 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75686-1636
Mailing Address - Country:US
Mailing Address - Phone:903-946-7995
Mailing Address - Fax:443-156-6278
Practice Address - Street 1:218 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686-1630
Practice Address - Country:US
Practice Address - Phone:903-946-7995
Practice Address - Fax:844-315-6627
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67321101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional