Provider Demographics
NPI:1821450065
Name:EVERETT, ARISKA (BA)
Entity Type:Individual
Prefix:
First Name:ARISKA
Middle Name:
Last Name:EVERETT
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:ARISKA
Other - Middle Name:
Other - Last Name:FORTENBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:560 BELLE TERRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-1715
Mailing Address - Country:US
Mailing Address - Phone:985-652-0078
Mailing Address - Fax:985-652-8360
Practice Address - Street 1:560 BELLE TERRE BLVD
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-1715
Practice Address - Country:US
Practice Address - Phone:985-652-0078
Practice Address - Fax:985-652-8360
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-26
Last Update Date:2016-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst