Provider Demographics
NPI:1932978277
Name:EVERGREEN BEHAVIORAL HEALTH INC.
Entity Type:Organization
Organization Name:EVERGREEN BEHAVIORAL HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSER
Authorized Official - Suffix:
Authorized Official - Credentials:CAP, ICADC
Authorized Official - Phone:386-487-9979
Mailing Address - Street 1:1206 SW MAIN BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-6603
Mailing Address - Country:US
Mailing Address - Phone:386-487-9979
Mailing Address - Fax:386-487-9979
Practice Address - Street 1:1206 SW MAIN BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-6603
Practice Address - Country:US
Practice Address - Phone:386-487-9979
Practice Address - Fax:386-487-9979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty