Provider Demographics
NPI:1073594776
Name:EVERGREEN COUNSELING CENTER
Entity Type:Organization
Organization Name:EVERGREEN COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:SAMMONS-COX
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT, LCDC
Authorized Official - Phone:832-877-0295
Mailing Address - Street 1:23777 COUNTY ROAD 125
Mailing Address - Street 2:
Mailing Address - City:BEDIAS
Mailing Address - State:TX
Mailing Address - Zip Code:77831-3373
Mailing Address - Country:US
Mailing Address - Phone:832-877-0295
Mailing Address - Fax:832-295-5752
Practice Address - Street 1:23777 COUNTY ROAD 125
Practice Address - Street 2:
Practice Address - City:BEDIAS
Practice Address - State:TX
Practice Address - Zip Code:77831-3373
Practice Address - Country:US
Practice Address - Phone:832-877-0295
Practice Address - Fax:832-295-5752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1393101YA0400X
TX10083101YM0800X
TX02054106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027038102Medicaid