NPIMap

Organization Active NPI

Evergreen Counseling Services, PC

  • Clinical Social Worker
  • Vancouver, WA
National Provider Identifier
1174754071
Registry record updated Jul 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LW00005079 Issued in WA
Legal business name
EVERGREEN COUNSELING SERVICES, PC
Practice address
1104 Main St
Suite #440
Vancouver, WA 98660-2999
Phone
(360) 694-3040
Fax
(360) 735-7484
NPI assigned
Jul 27, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2009

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

Authorized official

Name
Mr. Dale Edward Wotring, LICSWNPI 1578773685
Title
President
Phone
(360) 694-3040

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
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X LW00005079 WA Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X L0895 OR

Addresses

Primary practice location

1104 Main St
Suite #440
Vancouver, WA 98660-2999

Mailing address

1104 Main St
Suite #440
Vancouver, WA 98660-2999
Phone (360) 694-3040

Other names 1

  • Evergreen Counseling Services, PS Other name

National Provider Directory

National Provider Directory

Locations

1104 Main St
Ste 440
Vancouver, WA 98660
Phone (360) 518-6000

Practitioners & affiliated clinicians

Practitioners 5

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": "1248652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248652800000",
    "number": "1174754071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 MAIN ST",
            "address_2": "SUITE #440",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986602999",
            "telephone_number": "360-694-3040",
            "fax_number": "360-735-7484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 MAIN ST",
            "address_2": "SUITE #440",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986602999",
            "telephone_number": "360-694-3040",
            "fax_number": "360-735-7484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN COUNSELING SERVICES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-27",
        "last_updated": "2009-07-27",
        "status": "A",
        "authorized_official_last_name": "WOTRING",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-694-3040",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW00005079",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L0895",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Counseling Services, PS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2009; 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.