Provider Demographics
NPI:1720656135
Name:EVERGREEN THERAPY SERVICES-LLC
Entity Type:Organization
Organization Name:EVERGREEN THERAPY SERVICES-LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:785-483-9183
Mailing Address - Street 1:1819 11TH ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-4511
Mailing Address - Country:US
Mailing Address - Phone:785-483-9183
Mailing Address - Fax:
Practice Address - Street 1:1819 11TH ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-4511
Practice Address - Country:US
Practice Address - Phone:785-483-9183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-12
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty