Provider Demographics
NPI:1912509258
Name:EVERITT, MARIAH RENEE (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:RENEE
Last Name:EVERITT
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 LAKE GLN
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-8042
Mailing Address - Country:US
Mailing Address - Phone:281-382-8575
Mailing Address - Fax:
Practice Address - Street 1:313 E ANDERSON LN # 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1236
Practice Address - Country:US
Practice Address - Phone:512-961-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84526101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional