Provider Demographics
NPI:1366172041
Name:EVERGREEN COUNSELING AND WELLNESS, LLC
Entity type:Organization
Organization Name:EVERGREEN COUNSELING AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANTY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBBENNOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-221-9522
Mailing Address - Street 1:526 S CREYTS RD STE C
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8263
Mailing Address - Country:US
Mailing Address - Phone:517-221-9522
Mailing Address - Fax:
Practice Address - Street 1:526 S CREYTS RD STE C
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8263
Practice Address - Country:US
Practice Address - Phone:517-221-9522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty