Provider Demographics
NPI:1114534302
Name:EVERGREEN, TAYLOR A
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:A
Last Name:EVERGREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:A
Other - Last Name:KUEPFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5460 WARD RD STE 305
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1800
Mailing Address - Country:US
Mailing Address - Phone:720-828-2128
Mailing Address - Fax:
Practice Address - Street 1:5460 WARD RD STE 305
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-1800
Practice Address - Country:US
Practice Address - Phone:720-255-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099287201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical