Provider Demographics
NPI:1013579861
Name:WETTSTEIN, EVE ELISE (EDS)
Entity Type:Individual
Prefix:
First Name:EVE
Middle Name:ELISE
Last Name:WETTSTEIN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:EVE
Other - Middle Name:ELISE
Other - Last Name:ANDRSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS
Mailing Address - Street 1:520 BEVERLY ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-2506
Mailing Address - Country:US
Mailing Address - Phone:850-766-4426
Mailing Address - Fax:850-523-0864
Practice Address - Street 1:1801 N MERIDIAN RD STE C
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5266
Practice Address - Country:US
Practice Address - Phone:850-766-4426
Practice Address - Fax:850-523-0864
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL711103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool