Provider Demographics
NPI:1841609047
Name:EVERHEART, CORY (BCBA)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:EVERHEART
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 GARNET DR
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-8622
Mailing Address - Country:US
Mailing Address - Phone:863-944-3484
Mailing Address - Fax:
Practice Address - Street 1:4222 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1628
Practice Address - Country:US
Practice Address - Phone:863-204-6095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1841609047103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst