Provider Demographics
NPI:1174218358
Name:EVERGREEN PSYCHOTHERAPY APC
Entity type:Organization
Organization Name:EVERGREEN PSYCHOTHERAPY APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AKANKSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIVASTAV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:669-282-7234
Mailing Address - Street 1:1030 E EL CAMINO REAL # 362
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3759
Mailing Address - Country:US
Mailing Address - Phone:740-707-0488
Mailing Address - Fax:
Practice Address - Street 1:1580 W EL CAMINO REAL STE 2
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2461
Practice Address - Country:US
Practice Address - Phone:740-707-0488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health