Provider Demographics
NPI:1508116971
Name:EVANS, KEITH L JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:L
Last Name:EVANS
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-5741
Mailing Address - Country:US
Mailing Address - Phone:570-764-6444
Mailing Address - Fax:570-759-1935
Practice Address - Street 1:62 VILLAGE LN
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-5741
Practice Address - Country:US
Practice Address - Phone:570-764-6444
Practice Address - Fax:570-759-1935
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006020101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional