Provider Demographics
NPI:1407251960
Name:EVANS, KERRY MCGILL (LPCC)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:MCGILL
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 PETERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-8784
Mailing Address - Country:US
Mailing Address - Phone:859-647-0226
Mailing Address - Fax:
Practice Address - Street 1:3401 PETERSBURG RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-8784
Practice Address - Country:US
Practice Address - Phone:859-647-0226
Practice Address - Fax:859-594-4519
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0862101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional