Provider Demographics
NPI:1114195898
Name:THE EVERGREEN STATE COLLEGE
Entity type:Organization
Organization Name:THE EVERGREEN STATE COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COUNSELING & HEALTH SVC
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:360-867-6808
Mailing Address - Street 1:2700 EVERGREEN PKWY NW
Mailing Address - Street 2:SEMINAR 1 2110
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98505-0005
Mailing Address - Country:US
Mailing Address - Phone:360-867-6808
Mailing Address - Fax:360-867-6787
Practice Address - Street 1:2700 EVERGREEN PKWY NW
Practice Address - Street 2:SEMINAR 1 2110
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98505-0005
Practice Address - Country:US
Practice Address - Phone:360-867-6808
Practice Address - Fax:360-867-6787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health