Organization Active NPI

Evergreen Therapy & Wellness

  • Marriage & Family Therapist
  • Manhattan, KS
National Provider Identifier
1336858190
Registry record updated Dec 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
EVERGREEN THERAPY & WELLNESS
Practice address
206-10 Southwind Place Suite 2C
Manhattan, KS 66503
Phone
(785) 477-4400
NPI assigned
Nov 21, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2024

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

Authorized official

Name
Kassandra MoranNPI 1518675024
Title
Owner/Therapist
Phone
(785) 477-4400

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
Marriage & Family TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 106H00000X Primary

Addresses

Primary practice location

206-10 Southwind Place Suite 2C
Manhattan, KS 66503

Mailing address

206-10 Southwind Place Suite 2C
Manhattan, KS 66503
Phone (785) 477-4400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241210003519 KS Part B Supplier - Clinic/Group Practice 2365978665 Receives reassigned benefits from 2 practitioners
Practice locations: Manhattan, KS

National Provider Directory

National Provider Directory

Locations

206 Southwind Pl
Ste 2D
Manhattan, KS 66503
Phone (785) 477-4400

206 Southwind Pl
Ste 2C
Manhattan, KS 66503
Phone (785) 384-8813

Practitioners & affiliated clinicians

Practitioners 6

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": "1668988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733356800000",
    "number": "1336858190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206-10 SOUTHWIND PLACE SUITE 2C",
            "city": "MANHATTAN",
            "state": "KS",
            "postal_code": "66503",
            "telephone_number": "785-477-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206-10 SOUTHWIND PLACE SUITE 2C",
            "city": "MANHATTAN",
            "state": "KS",
            "postal_code": "66503",
            "telephone_number": "785-477-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN THERAPY & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-21",
        "last_updated": "2024-12-05",
        "certification_date": "2024-12-04",
        "status": "A",
        "authorized_official_last_name": "MORAN",
        "authorized_official_first_name": "KASSANDRA",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "785-477-4400"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manhattan, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.