Provider Demographics
NPI:1043893639
Name:EVERGREEN THERAPY
Entity Type:Organization
Organization Name:EVERGREEN THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:224-286-4290
Mailing Address - Street 1:200 N NORTHWEST HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-7500
Mailing Address - Country:US
Mailing Address - Phone:224-286-4290
Mailing Address - Fax:
Practice Address - Street 1:200 N NORTHWEST HWY STE 200
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-7500
Practice Address - Country:US
Practice Address - Phone:224-286-4290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty