Provider Demographics
NPI:1639793821
Name:EVERHART, KEVIN DALE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DALE
Last Name:EVERHART
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80201-0173
Mailing Address - Country:US
Mailing Address - Phone:303-854-4923
Mailing Address - Fax:303-558-4263
Practice Address - Street 1:1200 LARIMER STREET
Practice Address - Street 2:NORTH CLASSROOM BUILDING, SUITE 4036
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204
Practice Address - Country:US
Practice Address - Phone:303-854-4923
Practice Address - Fax:303-558-4263
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2578103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent