Provider Demographics
NPI:1326384587
Name:EVERITT, T'SHANA R (LMFT)
Entity Type:Individual
Prefix:
First Name:T'SHANA
Middle Name:R
Last Name:EVERITT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 CARTER CREEK PKWY
Mailing Address - Street 2:STE 204
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-4485
Mailing Address - Country:US
Mailing Address - Phone:979-450-0761
Mailing Address - Fax:
Practice Address - Street 1:4301 CARTER CREEK PKWY
Practice Address - Street 2:STE 204
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4485
Practice Address - Country:US
Practice Address - Phone:979-450-0761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201145106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist