Basic Information
| Provider Information | |||||||||
| NPI: | 1831829209 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVERETT | ||||||||
| FirstName: | MADISON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14714 DORSET LN | ||||||||
| Address2: | |||||||||
| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460624684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172134286 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1801 E 86TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462402345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887141927 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2022 | ||||||||
| LastUpdateDate: | 06/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 99112295A | IN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.