Healthcare Provider Details

I. General information

NPI: 1164093936
Provider Name (Legal Business Name): KASSAUNDRA EVERETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SW 7TH ST STE A
DES MOINES IA
50309-4538
US

IV. Provider business mailing address

209 10TH AVE S STE 350
NASHVILLE TN
37203-4166
US

V. Phone/Fax

Practice location:
  • Phone: 515-304-5505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number136668
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: