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General NPI Number Information
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NPI Number | 1316414907
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Entity Type | Organization
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Legal Business Name | EVERMIND INC
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Dates
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Enumeration Date | 11/01/2018
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Last Update Date | 11/01/2018
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Provider Practice Location Address
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Address Line | 4101 NEPTUNE RD STE A
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City | SAINT CLOUD
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State | FL
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Zip | 34769-6754
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Country | US
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Telephone | 321-223-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 4296 SASHA TRL
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City | SAINT CLOUD
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State | FL
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Zip | 34772-8869
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Country | US
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Telephone | 321-223-7070
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | JILLIAN GATZ
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Credential | LMFT
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Telephone | 321-223-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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