Organization Name: | EVERGREEN COUNSELING CENTER |
NPI Number: | 1306982434 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHIP DEITRICH (CHEIF FINANCIAL OFFICER) |
Mailing Address: | 205 8th St Hoquiam |
State: | WA US |
Postal Code: | 985502507 |
Phone Number: | 3605389227 |
Fax Number: | 3605328786 |
NPI Enumeration Date: | 01/29/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |