Provider Demographics
NPI:1295629806
Name:EVERGREEN COUNSELING AND CONSULTATION
Entity type:Organization
Organization Name:EVERGREEN COUNSELING AND CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LAFOUNTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:219-669-8267
Mailing Address - Street 1:2822 WALNUT CT
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OR
Mailing Address - Zip Code:97032-9692
Mailing Address - Country:US
Mailing Address - Phone:219-669-8267
Mailing Address - Fax:
Practice Address - Street 1:8855 SW HOLLY LN STE 111
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8793
Practice Address - Country:US
Practice Address - Phone:503-902-8431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-06
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)