Provider Demographics
NPI:1073810685
Name:EVITT, JUDITH (MC, EDD, LPC)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:EVITT
Suffix:
Gender:
Credentials:MC, EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11120 BENNETT DR UNIT 37
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34211-1141
Mailing Address - Country:US
Mailing Address - Phone:480-299-7042
Mailing Address - Fax:
Practice Address - Street 1:11120 BENNETT DR UNIT 37
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34211-1141
Practice Address - Country:US
Practice Address - Phone:480-299-7042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 12446101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional