NPIMap

Organization Active NPI

Evergreen Psychological Services

  • Clinical Neuropsychologist
  • Olympia, WA
National Provider Identifier
1184376048
Registry record updated Jan 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
Legal business name
EVERGREEN PSYCHOLOGICAL SERVICES
Practice address
1930 Black Lake Blvd SW # 102
Olympia, WA 98512-5651
Phone
(360) 347-6172
Fax
(360) 350-4619
NPI assigned
Jan 21, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2022

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

Authorized official

Name
Dr. Evan Lima, PHDNPI 1821237744
Title
Owner
Phone
(360) 347-6172

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X Primary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

1930 Black Lake Blvd SW # 102
Olympia, WA 98512-5651

Mailing address

1930 Black Lake Blvd SW # 102
Olympia, WA 98512-5651
Phone (360) 347-6172

National Provider Directory

National Provider Directory

Locations

1930 Black Lake Blvd SW
Ste 102
Olympia, WA 98512
Phone (360) 347-6172

1930 Black Lake Blvd SW
#102
Olympia, WA 98512
Phone (360) 347-6172

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1642723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642723200000",
    "number": "1184376048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 BLACK LAKE BLVD SW # 102",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985125651",
            "telephone_number": "360-347-6172",
            "fax_number": "360-350-4619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 BLACK LAKE BLVD SW # 102",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985125651",
            "telephone_number": "360-347-6172",
            "fax_number": "360-350-4619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-21",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A",
        "authorized_official_last_name": "LIMA",
        "authorized_official_first_name": "EVAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-347-6172",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2022; 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.