Provider Demographics
NPI:1699081109
Name:EVERGREEN COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:EVERGREEN COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:NIEDEREHE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:608-827-0400
Mailing Address - Street 1:6502 GRAND TETON PLZ
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1047
Mailing Address - Country:US
Mailing Address - Phone:608-827-0400
Mailing Address - Fax:608-276-5744
Practice Address - Street 1:6502 GRAND TETON PLZ
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1047
Practice Address - Country:US
Practice Address - Phone:608-827-0400
Practice Address - Fax:608-276-5744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)