Evergreen Counseling LLC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

LCPC-2674 Issued in ID

Legal business name

EVERGREEN COUNSELING LLC

Practice address

1920 E 17TH St Ste 240
Idaho Falls, ID 83404-8036

Phone

(208) 589-8690

Fax

(208) 523-8978

NPI assigned

Jun 22, 2017

Organization subpart

No

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

Authorized official

Name

Connie Croft, CPC

Title

Billing Manager

Phone

(208) 525-2090

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Susan M Holmes, LCPC

  • Mental Health Counselor
  • Idaho Falls, ID
  • NPI 1053780882
  NPD (past)

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

{
    "created_epoch": "1498089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498089600000",
    "number": "1285154054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046313",
            "telephone_number": "208-525-2090",
            "fax_number": "208-523-8978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 E 17TH ST STE 240",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048036",
            "telephone_number": "208-589-8690",
            "fax_number": "208-523-8978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-22",
        "last_updated": "2017-06-22",
        "status": "A",
        "authorized_official_last_name": "CROFT",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "208-525-2090",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": "ID",
            "license": "LCPC-2674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Counselor in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2017; 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.