EVERGREEN MENTAL HEALTH LLC (NPI# 1740715622) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740715622 |
| Entity Type | Organization |
| Organization Name | EVERGREEN MENTAL HEALTH LLC |
| Practice Address |
23403 E Mission Ave Ste 200i Liberty Lake WA 99019-7575 |
| Mailing Address |
Po Box 333 Liberty Lake WA 99019-0333 |
| Practice Telephone | 5099924224 |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2019-03-19 |
| Authorized Official Name | REGINA DAVIS (OWNER) |
| Authorized Official Telephone | 5099924224 |
| Authorized Official Credential | ARNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
AP60654992 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | EVERGREEN MENTAL HEALTH LLC | 23403 E Mission Ave Ste 200i, Liberty Lake, WA 99019-7575 |
| Street Address |
23403 E MISSION AVE STE 200I |
| City | LIBERTY LAKE |
| State | WA |
| Zip Code | 99019-7575 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952753717 | Regina Marie Davis | Nurse Practitioner | 23403 E Mission Ave Ste 200i, Liberty Lake, WA 99019-7575 | 2016-07-05 |
| 1811414402 | Catherine Louise Kuhn Brown | Psychologist | 23403 E Mission Ave Ste 200i, Liberty Lake, WA 99019-7575 | 2017-08-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194201533 | Lorena Margaret De La Rosa | Nurse Practitioner | 22820 E Appleway Ave Ste A, Liberty Lake, WA 99019 | 2018-07-18 |
| 1831641570 | Shirla Underwood | Spec/Tech, Cardiovascular | 3705 S Molter Rd, Liberty Lake, WA 99019 | 2016-10-28 |
| 1215393079 | Samuel Lionel Nelson | Chiropractor | 23801 East Appleway Ave, #110, Liberty Lake, WA 99019 | 2016-01-11 |
| 1841627601 | Noland Peterdy | Pharmacist | 1423 N Molter 727, Liberty Lake, WA 99019 | 2013-10-10 |
| 1043559446 | Phillip Wayne Harris | Reflexologist | E 23505 Appleway, Liberty Lake, WA 99019 | 2013-02-05 |
| 1710231766 | Mark Autrey | Pharmacist | 23010 E Settler Drive, Spokane, WA 99019 | 2012-10-30 |
| 1982971107 | Michele Ladd | Dental Hygienist | 22826 East Clearwater Lane, Liberty Lake, WA 99019 | 2011-11-17 |
| 1467689166 | Drostan Gregg Baker | Family Medicine | 2207 N Molter Rd Ste 203, Liberty Lake, WA 99019 | 2009-06-19 |
| 1619117959 | Joline Marie Messina | Behavioral Analyst | 1324 N Liberty Lake Rd # 193, Liberty Lake, WA 99019 | 2009-02-26 |
| 1144427964 | J. Evans, Dmd, P.s. | Dentist | 1327 N Stanford Lane, Suite B, Liberty Lake, WA 99019 | 2007-06-27 |
| Find all providers in zip 99019 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952753717 | Regina Marie Davis | Nurse Practitioner | 23403 E Mission Ave Ste 200i, Liberty Lake, WA 99019-7575 | 2016-07-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134720139 | Youwen Hu | Nurse Practitioner | 10824 Se 170th St Unit A304, Renton, WA 98055-5950 | 2020-11-05 |
| 1831799048 | Sarah Louise Weerheim | Nurse Practitioner | 2727 Hollycroft St Ste 110v, Gig Harbor, WA 98335-1371 | 2020-10-27 |
| 1619576774 | Bethany Heath Arnp-pmhnp Pllc | Nurse Practitioner | 1224 West Riverside, Apt 408, Spokane, WA 99201 | 2020-10-20 |
| 1437761988 | Hollye Hahn | Nurse Practitioner | 1012 Nw Longview Dr, Oak Harbor, WA 98277-8947 | 2020-08-17 |
| 1386254290 | Candie M. Wellwood | Nurse Practitioner | 9908 S Sherman Rd, Spokane, WA 99224-9811 | 2020-08-05 |
| 1104434679 | Progressive Psychiatric Consultant | Nurse Practitioner | 170 S Lincoln St # 150, Spokane, WA 99201-4443 | 2020-07-21 |
| 1235747213 | Peaceful Coexistence, LLC | Nurse Practitioner | 4730 University Way Ne Ste 104, Seattle, WA 98105-4424 | 2020-07-16 |
| 1134747066 | New Dawn Psychotherapy Pllc | Nurse Practitioner | 2223 Benson Rd S Apt D102, Renton, WA 98055-8837 | 2020-07-07 |
| 1376160861 | Clarity Behavioral Health | Nurse Practitioner | 7704 193rd Pl Sw, Edmonds, WA 98026-6234 | 2020-06-30 |
| 1174140677 | Rachael Davison | Nurse Practitioner | 22525 Se 64th Pl Ste 228, Issaquah, WA 98027-5383 | 2020-06-30 |
| Find all providers with the same taxonomy | ||||
| City | LIBERTY LAKE |
| Zip Code | 99019 |
Please comment or provide details below to improve the information on EVERGREEN MENTAL HEALTH LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.