Provider Demographics
NPI:1275135246
Name:EVERETT, J MATTHEW (LPC)
Entity Type:Individual
Prefix:MR
First Name:J
Middle Name:MATTHEW
Last Name:EVERETT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 ORLANDO DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-3339
Mailing Address - Country:US
Mailing Address - Phone:334-701-3858
Mailing Address - Fax:
Practice Address - Street 1:4455 S PADRE ISLAND DR STE 101
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5125
Practice Address - Country:US
Practice Address - Phone:334-701-3858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76157101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health