Provider Demographics
NPI:1891306973
Name:EVERGREEN THERAPY LLC
Entity Type:Organization
Organization Name:EVERGREEN THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:541-399-4411
Mailing Address - Street 1:243 W 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3008
Mailing Address - Country:US
Mailing Address - Phone:541-279-2245
Mailing Address - Fax:541-804-7380
Practice Address - Street 1:1245 PEARL ST STE 208
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3564
Practice Address - Country:US
Practice Address - Phone:541-279-2245
Practice Address - Fax:541-804-7380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty