Provider Demographics
NPI:1295160778
Name:EVERT, JAMIE LEE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:EVERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18014 SHERMAN WAY
Mailing Address - Street 2:#223
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18014 SHERMAN WAY
Practice Address - Street 2:#223
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4643
Practice Address - Country:US
Practice Address - Phone:262-271-9976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist