Provider Demographics
NPI:1417704941
Name:EVERETT, COLLIN
Entity type:Individual
Prefix:MR
First Name:COLLIN
Middle Name:
Last Name:EVERETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9255 NE ROCKSPRING ST APT B327
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-2224
Mailing Address - Country:US
Mailing Address - Phone:801-608-6491
Mailing Address - Fax:
Practice Address - Street 1:9255 NE ROCKSPRING ST APT B327
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-2224
Practice Address - Country:US
Practice Address - Phone:801-608-6491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health