Provider Demographics
NPI:1023712056
Name:EVERGREEN COUNSELING LLC
Entity type:Organization
Organization Name:EVERGREEN COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:ECHTENKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-616-3237
Mailing Address - Street 1:6790 GROVER ST STE 250
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3645
Mailing Address - Country:US
Mailing Address - Phone:402-988-1533
Mailing Address - Fax:
Practice Address - Street 1:6790 GROVER ST STE 250
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3645
Practice Address - Country:US
Practice Address - Phone:402-988-1533
Practice Address - Fax:614-658-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty