Evergreen Psychological Services

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

Legal business name

EVERGREEN PSYCHOLOGICAL SERVICES

Practice address

313 College Ave
Oskaloosa, IA 52577-1700

Phone

(641) 670-0388

NPI assigned

Feb 27, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Thomas Potter, PH.D.

Title

Psychologist

Phone

(641) 670-0388

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1267228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267228800000",
    "number": "1104148485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 COLLEGE AVE",
            "city": "OSKALOOSA",
            "state": "IA",
            "postal_code": "525771700",
            "telephone_number": "641-670-0388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 COLLEGE AVE",
            "city": "OSKALOOSA",
            "state": "IA",
            "postal_code": "525771700",
            "telephone_number": "641-670-0388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-27",
        "last_updated": "2010-02-27",
        "status": "A",
        "authorized_official_last_name": "POTTER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "641-670-0388",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982760070",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.