Provider Demographics
NPI:1386177392
Name:EVERETEZE, REINE (PSYD)
Entity type:Individual
Prefix:
First Name:REINE
Middle Name:
Last Name:EVERETEZE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:REINE
Other - Middle Name:HELENA
Other - Last Name:EVERETEZE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:12136 W. BAYAUD AVE, STE 140
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2115
Mailing Address - Country:US
Mailing Address - Phone:303-202-6143
Mailing Address - Fax:303-202-6146
Practice Address - Street 1:12136 W. BAYAUD AVE, STE 140
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2115
Practice Address - Country:US
Practice Address - Phone:303-202-6143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0003779103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist