Provider Demographics
NPI:1619098811
Name:EVERETT, SANDRA JO (MA)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JO
Last Name:EVERETT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1862 W 800 N
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2788
Mailing Address - Country:US
Mailing Address - Phone:801-447-9178
Mailing Address - Fax:
Practice Address - Street 1:930 W HILL FIELD RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4662
Practice Address - Country:US
Practice Address - Phone:801-336-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7942986-3902106H00000X
CAMFC 46543106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist