Provider Demographics
NPI:1699988956
Name:ANTHONY, EVERETT R (MS COUNSELING)
Entity type:Individual
Prefix:MR
First Name:EVERETT
Middle Name:R
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:MS COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8619 FENWICK CREEK PL APT F
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-5841
Mailing Address - Country:US
Mailing Address - Phone:502-500-6652
Mailing Address - Fax:502-491-6671
Practice Address - Street 1:8619 FENWICK CREEK PL APT F
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-5841
Practice Address - Country:US
Practice Address - Phone:502-500-6652
Practice Address - Fax:502-491-6671
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA93099275101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor