NPIMap

Organization Active NPI

Evergreen Telepsychiatry PLLC

  • Clinic/Center
  • Kirkland, WA
National Provider Identifier
1205593449
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
EVERGREEN TELEPSYCHIATRY PLLC
Practice address
11335 NE 122ND Way Ste 105
Kirkland, WA 98034-6933
Phone
(206) 451-7150
NPI assigned
Nov 23, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

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

Authorized official

Name
Joseph Michael UngvarskyNPI 1093382277
Title
Founder/Pmhnp-BC
Phone
(570) 417-3318

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

11335 NE 122ND Way Ste 105
Kirkland, WA 98034-6933

Mailing address

11335 NE 122ND Way Ste 105
Kirkland, WA 98034-6933
Phone (206) 451-7150

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL intakeq.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1637625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1205593449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11335 NE 122ND WAY STE 105",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980346933",
            "telephone_number": "206-451-7150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11335 NE 122ND WAY STE 105",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980346933",
            "telephone_number": "206-451-7150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN TELEPSYCHIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-23",
        "last_updated": "2023-09-06",
        "certification_date": "2021-11-29",
        "status": "A",
        "authorized_official_last_name": "UNGVARSKY",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "FOUNDER/PMHNP-BC",
        "authorized_official_telephone_number": "570-417-3318"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "intakeq.com",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11335 NE 122nd Way Ste 105",
            "city": "Kirkland",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980346933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; 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.