Marilee Eveleth, LAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

1093023 Issued in AZ

Practice address

16 E Route 66 Ste 203
Flagstaff, AZ 86001-5777

Phone

(928) 606-2907

NPI assigned

Aug 13, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Flagtown Therapy, LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Flagstaff, AZ
  • NPI 1669117206
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628812800000",
    "number": "1649945379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 E ROUTE 66 STE 203",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860015777",
            "telephone_number": "928-606-2907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 E ROUTE 66 STE 203",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860015777",
            "telephone_number": "928-606-2907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVELETH",
        "first_name": "MARILEE",
        "credential": "LAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-13",
        "last_updated": "2021-08-13",
        "certification_date": "2021-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "1093023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Estes
• Susan F Etsitty, PHARMD
• Stuart Allen Eurich
• Nancy Marie Evans, MA, NCSP
• Robert M Evans, PA-C
• Shelley Lee Everly, M.D.
• Evolve Flagstaff LLC
• Adam Christopher Fajardo
• Eddie Walid Fakhouri, MD
• Family Care Home Health and Hospice

• Mental Health Counselor in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Mental Health Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.