KELLEY F EVERSON (LPC) – Professional Counselor, NPI 1053685602

KELLEY F EVERSON (LPC) is a healthcare provider. based in Janesville, Wisconsin. specializing in MENTAL HEALTH COUNSELOR. They hold the professional credentials LPC. They hold a License No. 4673-125 (WI). The NPI Number for KELLEY F EVERSON (LPC) is 1053685602

Main info

Female
22 Years Of Experience
Accepts Medicare Assignment
Name
KELLEY F EVERSON (LPC)
NPI
1053685602
Phone
(608) 755-5260
Address
17 S RIVER ST
Enumeration Date
29 February 2012
Last Update Date
29 February 2012

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6083688087
Graduation Year
2004 (22 years ago)
PAC ID
1355793795
Group Practice PAC ID
1658655865
Professional Enrollment ID
I20240122001002
Address ID
WI535116314BE540XXAVEX400
Telehealth
Yes
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience42
Completeness75
Years active:14State licenses:1Digital endpointsOther names

1,777 MENTAL HEALTH COUNSELOR in WI

Provider Addresses for KELLEY F EVERSON (LPC)

  • 17 S RIVER ST

    254

    JANESVILLE, WI 535483860

    Phone: (608) 755-5260

    Fax: (608) 755-5267

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-01-22

PECOS data refreshed: 2026-06-15

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240122001002IMental Health CounselorWITBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 53548)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1658655865View full group profile
NameSpecialtyState
Nurse PractitionerWI
Clinical Social WorkerWI
Clinical Social WorkerWI
Clinical Social WorkerWI
Clinical Social WorkerWI
Mental Health CounselorWI
Clinical Social WorkerWI
Clinical Social WorkerWI
Clinical Social WorkerWI
Mental Health CounselorWI

Reviews

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Frequently asked questions

Can I verify KELLEY F EVERSON (LPC) with an NPI only?
You can start verification with NPI 1053685602 for KELLEY F EVERSON (LPC), then check state licensing separately.
Is KELLEY F EVERSON (LPC) listed as active for patients and plans?
The listing shows KELLEY F EVERSON (LPC) as active in the NPI system.
What taxonomy line describes KELLEY F EVERSON (LPC)?
For research purposes, treat KELLEY F EVERSON (LPC) as Professional Counselor in this dataset. Clinical services aligned with this taxonomy classification.
Where is KELLEY F EVERSON (LPC) based?
KELLEY F EVERSON (LPC) is tied to Janesville, Wisconsin in the data we show; additional addresses may exist on the full record.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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