Provider Demographics
NPI:1033827233
Name:EVERTZ, KELLY ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:EVERTZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BANKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SILVER BAY
Mailing Address - State:MN
Mailing Address - Zip Code:55614-1339
Mailing Address - Country:US
Mailing Address - Phone:320-424-0714
Mailing Address - Fax:
Practice Address - Street 1:404 W SUPERIOR ST STE 210
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1569
Practice Address - Country:US
Practice Address - Phone:218-606-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4397106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist