Provider Demographics
NPI:1710128822
Name:EVERSON, COURTNEY (MSW LCSW RPT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:EVERSON
Suffix:
Gender:F
Credentials:MSW LCSW RPT
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:SCHAEFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW RPT
Mailing Address - Street 1:2500 S BRENTWOOD BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2309
Mailing Address - Country:US
Mailing Address - Phone:314-266-8545
Mailing Address - Fax:
Practice Address - Street 1:2500 S BRENTWOOD BLVD STE 211
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-2309
Practice Address - Country:US
Practice Address - Phone:314-266-8545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080370491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11977937OtherCAQH