EVERGREEN COACHING AND COUNSELING INC. NPI 1649743360

NPI Information

NPI: 1649743360
Provider Name: EVERGREEN COACHING AND COUNSELING, INC.
Classification: Clinic/Center - 261QM0850X
Entity Type: Organization

Specialization: Adult Mental Health

Address:
411 E PARK ST STE 106
CHAMPAIGN, IL
ZIP 61820
Phone: (217) 714-7042
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EVERGREEN COACHING AND 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 AND COUNSELING, INC. NPI is 1649743360. 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 President/psychologist and has the following contact phone number (217) 714-7042.

The enumeration date for this NPI number is 1/4/2019 and was last updated on 8/22/2023.

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
1	261QM0855X	Clinic/Center	Adolescent and Children Mental Health			No
2	261QM0850X	Clinic/Center	Adult Mental Health			Yes

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: 5/5/2024

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