Provider Demographics
NPI:1750060810
Name:EVERGREEN PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:EVERGREEN PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TROESE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:412-600-9266
Mailing Address - Street 1:7155 PEARL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-4945
Mailing Address - Country:US
Mailing Address - Phone:412-600-9266
Mailing Address - Fax:440-545-1055
Practice Address - Street 1:7155 PEARL RD STE 102
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-4945
Practice Address - Country:US
Practice Address - Phone:412-600-9266
Practice Address - Fax:440-545-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty