Provider Demographics
NPI:1851879852
Name:EVERAGE, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:EVERAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 BOWERS HOLLOW AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89085-4478
Mailing Address - Country:US
Mailing Address - Phone:323-578-6963
Mailing Address - Fax:
Practice Address - Street 1:2950 S RANCHO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0702
Practice Address - Country:US
Practice Address - Phone:702-754-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health