Healthcare Provider Details

I. General information

NPI: 1871404210
Provider Name (Legal Business Name): ANITA EVERLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34121 N US HIGHWAY 45 STE 221
GRAYSLAKE IL
60030-1774
US

IV. Provider business mailing address

100 N WAUKEGAN RD STE 204
LAKE BLUFF IL
60044-1660
US

V. Phone/Fax

Practice location:
  • Phone: 847-821-9346
  • Fax:
Mailing address:
  • Phone: 847-821-9346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.033307
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: