Provider Demographics
NPI:1083462295
Name:EVERETT, AMALIA M (LPC)
Entity type:Individual
Prefix:
First Name:AMALIA
Middle Name:M
Last Name:EVERETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 4TH ST W
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-2216
Mailing Address - Country:US
Mailing Address - Phone:830-279-1386
Mailing Address - Fax:
Practice Address - Street 1:1100 NW LOOP 410 STE 700
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2258
Practice Address - Country:US
Practice Address - Phone:210-374-4207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-11
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health