Kelley F Everson, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4673-125 Issued in WI

Practice address

17 S River St
254
Janesville, WI 53548-3860

Phone

(608) 755-5260

Fax

(608) 755-5267

NPI assigned

Feb 29, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Stateline Mental Health ServicesGroup PAC ID 1658655865, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Stateline Mental Health Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Beloit, WI
  • NPI 1538560255

  Professional

  Medicare reassignment Care Compare group NPD
• Trivium LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Janesville, WI
  • NPI 1265450753
  NPD (past)
• Trivium LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Sun Prairie, WI
  • NPI 1427463066
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330473600000",
    "number": "1053685602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 S RIVER ST",
            "address_2": "254",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535483860",
            "telephone_number": "608-755-5260",
            "fax_number": "608-755-5267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 S RIVER ST",
            "address_2": "254",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535483860",
            "telephone_number": "608-755-5260",
            "fax_number": "608-755-5267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVERSON",
        "first_name": "KELLEY",
        "middle_name": "F",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-29",
        "last_updated": "2012-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "4673-125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Sue Erickson, R.N.
• Michelle B Esch, PA-C
• Ellen Jean Ettlie, APNP
• Isaac C Evenson
• Amanda Joy Everson, LMT
• Juliene Marie Ewers
• Alison Ewing, OTR
• Debra J Ewing, DO
• Eyemart Express LLC
• Eyemart Express LTD

• Professional Counselor in Janesville, WI
• Providers in Janesville, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.