Provider Demographics
NPI:1962997015
Name:EVERMIND LLC
Entity type:Organization
Organization Name:EVERMIND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GATZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:321-223-7070
Mailing Address - Street 1:4296 SASHA TRL
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-8869
Mailing Address - Country:US
Mailing Address - Phone:321-223-7070
Mailing Address - Fax:
Practice Address - Street 1:4101 NEPTUNE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6754
Practice Address - Country:US
Practice Address - Phone:321-223-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3287106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty