Provider Demographics
NPI:1942915772
Name:EVERS, JESSIE MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:MARIE
Last Name:EVERS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 E GEMINI DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3155
Mailing Address - Country:US
Mailing Address - Phone:480-772-5828
Mailing Address - Fax:
Practice Address - Street 1:10613 N HAYDEN RD UNIT J-103
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5683
Practice Address - Country:US
Practice Address - Phone:480-772-5828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC20340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health