Provider Demographics
NPI:1346418753
Name:EVASHEVSKI, KEITH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:EVASHEVSKI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 SHIELD ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2244
Mailing Address - Country:US
Mailing Address - Phone:307-761-0615
Mailing Address - Fax:
Practice Address - Street 1:1050 N 3RD ST
Practice Address - Street 2:SUITE B1
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2544
Practice Address - Country:US
Practice Address - Phone:307-742-9766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY382103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical