Provider Demographics
NPI:1639239270
Name:VAN EVERY, EUGENE (LCSW)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:VAN EVERY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 HOSPITAL CIR
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:MS
Mailing Address - Zip Code:39350-6781
Mailing Address - Country:US
Mailing Address - Phone:601-656-2211
Mailing Address - Fax:
Practice Address - Street 1:210 HOSPITAL CIR
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:MS
Practice Address - Zip Code:39350-6781
Practice Address - Country:US
Practice Address - Phone:601-656-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSCO3071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P59079Medicare UPIN
TX8EZ50GMedicare PIN
TX8EZ41GMedicare PIN
TX8EZ60GMedicare PIN
TX8EZ70GMedicare PIN