Provider Demographics
NPI:1265275226
Name:EVERETT, HARRY (DMIN)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:EVERETT
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-0012
Mailing Address - Country:US
Mailing Address - Phone:214-450-0115
Mailing Address - Fax:
Practice Address - Street 1:163 TOWN PL
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TX
Practice Address - Zip Code:75069-1821
Practice Address - Country:US
Practice Address - Phone:214-450-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral