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General NPI Number Information
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NPI Number | 1861984601
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Entity Type | Organization
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Legal Business Name | MICHAEL EVERSON
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 03/02/2021
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Provider Practice Location Address
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Address Line | 8037 FAIR OAKS BLVD STE 110
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City | CARMICHAEL
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State | CA
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Zip | 95608-6742
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Country | US
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Telephone | 916-905-3395
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Fax | 916-905-0315
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Provider Business Mailing Address
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Address Line | 8037 FAIR OAKS BLVD STE 110
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City | CARMICHAEL
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State | CA
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Zip | 95608-6742
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Country | US
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Telephone | 916-905-3395
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Fax | 916-692-8500
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Authorized Official
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Title or Position | LICENSED MARRIAGE & FAMILY THERAPIS
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Name | MICHAEL EVERSON
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Credential | LMFT #97556
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Telephone | 916-905-3395
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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 | LMFT97556
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License Number State | CA
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