MEDICARE: MS. EVELYN G. KEATHLEY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	67321	TX

General Provider Information

NPI Number	:	1588912208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EVELYN G. KEATHLEY LPC

Provider Business Mailing Address
First Line	:	122 FULTON ST
Second Line	:
City	:	PITTSBURG
State	:	TX
Zip	:	75686-1636
Country	:	US
Telephone Number	:	903-946-7995
Fax Number	:	443-156-6278

Provider Business Practice Location Address
First Line	:	218 LAFAYETTE ST
Second Line	:
City	:	PITTSBURG
State	:	TX
Zip	:	75686-1630
Country	:	US
Telephone Number	:	903-946-7995
Fax Number	:	844-315-6627

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	10/10/2023

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