Provider Demographics
NPI:1831681600
Name:EVERGREEN COUNSELING LLC
Entity type:Organization
Organization Name:EVERGREEN COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:213-222-5079
Mailing Address - Street 1:2100 MANCHESTER RD STE 602
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4587
Mailing Address - Country:US
Mailing Address - Phone:630-480-0060
Mailing Address - Fax:630-981-2094
Practice Address - Street 1:2100 MANCHESTER RD STE 602
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4587
Practice Address - Country:US
Practice Address - Phone:213-222-5079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0855X, 261QM0850X, 101YM0800X
IL166.001114106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty