NPIMap

Organization Active NPI

Evergreen Therapy Center LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • North Liberty, IA
National Provider Identifier
1043828825
Registry record updated Nov 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
EVERGREEN THERAPY CENTER LLC
Practice address
595 Ashley CT Ste 5
North Liberty, IA 52317-4758
Phone
(319) 853-8762
Fax
(319) 249-6875
NPI assigned
Jul 17, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jason Matthew Drwal, PH.D.NPI 1164669594
Title
President
Phone
(319) 853-8762

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Adult Mental Health Clinic/Center 261QM0850X

Addresses

Primary practice location

595 Ashley CT Ste 5
North Liberty, IA 52317-4758

Mailing address

595 Ashley CT Ste 5
North Liberty, IA 52317-4758
Phone (319) 853-8762

Other names 1

  • Evergreen Therapy Center LLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210929000624 IA Part B Supplier - Clinic/Group Practice 8527465863 Receives reassigned benefits from 6 practitioners
Practice locations: North Liberty, IA

National Provider Directory

National Provider Directory

Locations

375 Collins Rd NE
Ste 103
Cedar Rapids, IA 52402
Phone (319) 853-8762

2140 Norcor Ave
Ste 103
Coralville, IA 52241

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763769600000",
    "number": "1043828825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 ASHLEY CT STE 5",
            "city": "NORTH LIBERTY",
            "state": "IA",
            "postal_code": "523174758",
            "telephone_number": "319-853-8762",
            "fax_number": "319-249-6875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 ASHLEY CT STE 5",
            "city": "NORTH LIBERTY",
            "state": "IA",
            "postal_code": "523174758",
            "telephone_number": "319-853-8762",
            "fax_number": "319-249-6875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN THERAPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-17",
        "last_updated": "2025-11-22",
        "certification_date": "2025-11-22",
        "status": "A",
        "authorized_official_last_name": "DRWAL",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "319-853-8762",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Therapy Center LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in North Liberty, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.