Healthcare Provider Details

I. General information

NPI: 1003926338
Provider Name (Legal Business Name): MS. DEBORAH EVERSOLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 BOH LN
HAZARD KY
41701-6583
US

IV. Provider business mailing address

PO BOX 2011
HAZARD KY
41702-2011
US

V. Phone/Fax

Practice location:
  • Phone: 606-551-1140
  • Fax: 606-435-7558
Mailing address:
  • Phone: 606-435-7557
  • Fax: 606-435-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number171746
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: