Provider Demographics
NPI:1649002387
Name:EVERGREEN COUNSELING LLC
Entity type:Organization
Organization Name:EVERGREEN COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KILEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:503-334-9414
Mailing Address - Street 1:937 NE TILLAMOOK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-4059
Mailing Address - Country:US
Mailing Address - Phone:503-334-9414
Mailing Address - Fax:844-222-4353
Practice Address - Street 1:937 NE TILLAMOOK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-4059
Practice Address - Country:US
Practice Address - Phone:503-334-9414
Practice Address - Fax:844-222-4353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC6961OtherLPC
OR500701824Medicaid
WAMHC.LH.60910450OtherLMHC
101YM0800XOtherTAXONOMY CODE