EVERGREEN COACHING & COUNSELING INC. NPI 1265114219

NPI Information

  • NPI: 1265114219
  • Provider Name: EVERGREEN COACHING & COUNSELING, INC.
  • Classification: Clinic/Center - 261QM0850X
  • Specialization: Adult Mental Health
  • Entity Type: Organization
  • Address: 411 E PARK ST STE 106
    CHAMPAIGN, IL
    ZIP 61820
  • Phone: (217) 714-7042

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NPI Details

EVERGREEN COACHING & COUNSELING, INC. is an adult mental health clinic center in Champaign, IL. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. EVERGREEN COACHING & COUNSELING, INC. NPI is 1265114219. The provider is registered as an organization entity type.

The provider's business location address is:

411 E PARK ST STE 106
CHAMPAIGN, IL
ZIP 61820-862
Phone: (217) 714-7042
Fax: (866) 216-6514

The provider's authorized official is Jonathan William Thomas-stagg .
The authorized official title is Owner and has the following contact phone number (217) 714-7042.

The enumeration date for this NPI number is 8/1/2023 and was last updated on 8/28/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0855XClinic/CenterAdolescent and Children Mental HealthNo
2261QM0850XClinic/CenterAdult Mental HealthYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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