Provider Demographics
NPI:1053119396
Name:MORTON, EVELYN MARIE (N/A)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:MARIE
Last Name:MORTON
Suffix:
Gender:
Credentials:N/A
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:MARIE
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:1551 ARISTIDES BLVD APT. 1421
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1674
Mailing Address - Country:US
Mailing Address - Phone:859-979-6120
Mailing Address - Fax:
Practice Address - Street 1:2197 VERSAILLES ROAD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504
Practice Address - Country:US
Practice Address - Phone:859-979-6120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY305R00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No305R00000XManaged Care OrganizationsPreferred Provider Organization