NPIMap

Organization Active NPI

Evergreen Behavioral Health PC

Doing business as Evergreen Behavioral Health

  • Clinical Psychologist
  • Vancouver, WA
National Provider Identifier
1205146776
Registry record updated Oct 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
EVERGREEN BEHAVIORAL HEALTH PC
Doing business as
Evergreen Behavioral Health
Practice address
2621 NE 134TH St Ste 340
Vancouver, WA 98686-3036
Phone
(360) 450-0140
Fax
(877) 343-0535
NPI assigned
Oct 18, 2010
Last updated
Oct 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2014

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

Authorized official

Name
Jill B Fancher, PH.D.NPI 1205083938
Title
Clinic Director/Owner
Phone
(360) 450-0140

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Psychologist 103TC0700X Primary
Clinical Social Worker 1041C0700X
Massage Therapist 225700000X

Addresses

Primary practice location

2621 NE 134TH St Ste 340
Vancouver, WA 98686-3036

Mailing address

2621 NE 134TH St Ste 340
Vancouver, WA 98686-3036
Phone (360) 450-0140

Other names 1

  • Evergreen Behavioral Health Doing business as

National Provider Directory

National Provider Directory

Locations

108 SE 124th Ave
Ste 21
Vancouver, WA 98684
Phone (360) 450-0140

717 NE 61st St
Ste 202
Vancouver, WA 98665
Phone (360) 217-9434

800 NE Tenney Rd
Ste 110559
Vancouver, WA 98685

811 NE 112th Ave
Ste 108
Vancouver, WA 98684
Phone (360) 450-0140

Practitioners & affiliated clinicians

Practitioners 9

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": "1287360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413849600000",
    "number": "1205146776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 NE 134TH ST STE 340",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986863036",
            "telephone_number": "360-450-0140",
            "fax_number": "877-343-0535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 NE 134TH ST STE 340",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986863036",
            "telephone_number": "360-450-0140",
            "fax_number": "877-343-0535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN BEHAVIORAL HEALTH PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-18",
        "last_updated": "2014-10-21",
        "status": "A",
        "authorized_official_last_name": "FANCHER",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CLINIC DIRECTOR/OWNER",
        "authorized_official_telephone_number": "360-450-0140",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 21, 2014; 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.