Provider Demographics
NPI:1427196005
Name:EVERGREEN PSYCHOTHERAPY CENTER
Entity Type:Organization
Organization Name:EVERGREEN PSYCHOTHERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-674-4029
Mailing Address - Street 1:32065 CASTLE CT
Mailing Address - Street 2:SUITE 325
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9586
Mailing Address - Country:US
Mailing Address - Phone:303-674-4029
Mailing Address - Fax:303-674-4078
Practice Address - Street 1:32065 CASTLE CT
Practice Address - Street 2:SUITE 325
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9586
Practice Address - Country:US
Practice Address - Phone:303-674-4029
Practice Address - Fax:303-674-4078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty