Provider Demographics
NPI:1609003813
Name:EVERGREEN COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:EVERGREEN COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BRUNETTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:724-845-9880
Mailing Address - Street 1:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-0472
Mailing Address - Country:US
Mailing Address - Phone:724-845-9880
Mailing Address - Fax:724-353-1083
Practice Address - Street 1:415 E 4TH AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084-1847
Practice Address - Country:US
Practice Address - Phone:724-845-9880
Practice Address - Fax:724-353-1083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003332101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102227731 0001Medicaid