Provider Demographics
NPI:1962109876
Name:EVERGREEN MENTAL HEALTH COUNSELING, PLLC
Entity type:Organization
Organization Name:EVERGREEN MENTAL HEALTH COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:518-250-9634
Mailing Address - Street 1:6 BEAR BROOK CT
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-2738
Mailing Address - Country:US
Mailing Address - Phone:518-250-9634
Mailing Address - Fax:
Practice Address - Street 1:6 BEAR BROOK CT
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2738
Practice Address - Country:US
Practice Address - Phone:518-250-9634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty