Provider Demographics
NPI:1356467344
Name:EYERLY, VIRGINIA LEE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:LEE
Last Name:EYERLY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:LEE
Other - Last Name:EYERLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:826 CRENSHAW LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-8129
Mailing Address - Country:US
Mailing Address - Phone:813-909-7802
Mailing Address - Fax:813-948-6325
Practice Address - Street 1:4425 PARK BLVD
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3540
Practice Address - Country:US
Practice Address - Phone:727-547-0607
Practice Address - Fax:727-547-6752
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2218106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist