Provider Demographics
NPI:1306969399
Name:EVERETT, ELIZABETH GABRIELA
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GABRIELA
Last Name:EVERETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:GABRIELA
Other - Last Name:EVERETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1340 HANCHETT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2605
Mailing Address - Country:US
Mailing Address - Phone:561-389-0896
Mailing Address - Fax:
Practice Address - Street 1:1340 HANCHETT AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2605
Practice Address - Country:US
Practice Address - Phone:561-389-0896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health