Provider Demographics
NPI:1023050770
Name:EVERGREEN PSYCHOLOGICAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:EVERGREEN PSYCHOLOGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHC/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HELGI
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOUAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:360-740-8533
Mailing Address - Street 1:57 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-4815
Mailing Address - Country:US
Mailing Address - Phone:360-740-8533
Mailing Address - Fax:360-740-8534
Practice Address - Street 1:57 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-4815
Practice Address - Country:US
Practice Address - Phone:360-740-8533
Practice Address - Fax:360-740-8534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB15829Medicare UPIN