Provider Demographics
NPI:1568667764
Name:EVERGREEN BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:EVERGREEN BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:FINDER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:573-582-0292
Mailing Address - Street 1:PO BOX 871
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-0871
Mailing Address - Country:US
Mailing Address - Phone:573-582-0292
Mailing Address - Fax:573-581-6036
Practice Address - Street 1:116 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2842
Practice Address - Country:US
Practice Address - Phone:573-582-0292
Practice Address - Fax:573-581-6036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPYO1319251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health