Provider Demographics
NPI:1578789020
Name:EVERGREEN COUNSELING, INC.
Entity Type:Organization
Organization Name:EVERGREEN COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-248-6290
Mailing Address - Street 1:5300 W SAHARA AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0353
Mailing Address - Country:US
Mailing Address - Phone:702-248-6290
Mailing Address - Fax:702-248-4720
Practice Address - Street 1:5300 W SAHARA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0353
Practice Address - Country:US
Practice Address - Phone:702-248-6290
Practice Address - Fax:702-248-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01761-C251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health