Provider Demographics
NPI:1679144398
Name:EVERGREEN PSYCHIATRIC SERVICES, PLLC
Entity Type:Organization
Organization Name:EVERGREEN PSYCHIATRIC SERVICES, PLLC
Other - Org Name:SANTOSHA INTEGRATIVE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MEUNIER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, ARNP
Authorized Official - Phone:206-502-0991
Mailing Address - Street 1:7001 SEAVIEW AVE NW STE 160-380
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-6006
Mailing Address - Country:US
Mailing Address - Phone:206-502-0991
Mailing Address - Fax:206-326-1012
Practice Address - Street 1:1700 7TH AVE STE 2100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1360
Practice Address - Country:US
Practice Address - Phone:206-502-0991
Practice Address - Fax:206-326-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-03
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty