Basic Information
| Provider Information | |||||||||
| NPI: | 1750637112 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVERITT | ||||||||
| FirstName: | MARGOT | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MA LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 913 E 82ND ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462402305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233332339 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2345 S LYNHURST DR | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462418630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172478900 | ||||||||
| FaxNumber: | 3172478935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2012 | ||||||||
| LastUpdateDate: | 08/15/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 35001764A | IN | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.