Evergrace Therapy LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

EVERGRACE THERAPY LLC

Practice address

10104 S Utica Ave
Evergreen Park, IL 60805-3527

Phone

(304) 280-6360

NPI assigned

Jan 4, 2024

Organization subpart

No

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

Authorized official

Name

Mrs. Samantha M Vazquez, LCPCNPI 1790207868

Title

Owner/Psychotherapist

Phone

(304) 280-6360

Specialties & licenses 1

Addresses

Practitioners 1

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

• Samantha Marie Vazquez, LCPC

  • Mental Health Counselor
  • Evergreen Park, IL
  • NPI 1790207868
  NPD Authorized official

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

{
    "created_epoch": "1704326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704326400000",
    "number": "1164292645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10104 S UTICA AVE",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608053527",
            "telephone_number": "304-280-6360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10104 S UTICA AVE",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608053527",
            "telephone_number": "304-280-6360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGRACE THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-04",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A",
        "authorized_official_last_name": "VAZQUEZ",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "304-280-6360",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Mental Health Clinic/Center in Evergreen Park, IL
• Providers in Evergreen Park, IL by specialty
• Adult Mental Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; 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.