Provider Demographics
NPI:1184817744
Name:EVERETT, DENISE LUCILLE (MFT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LUCILLE
Last Name:EVERETT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 LAKESIDE CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4829
Mailing Address - Country:US
Mailing Address - Phone:775-786-6880
Mailing Address - Fax:
Practice Address - Street 1:3500 LAKESIDE CT
Practice Address - Street 2:SUITE 101
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4829
Practice Address - Country:US
Practice Address - Phone:775-786-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0713106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist