Evergreen Assessment & Consultation LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

EVERGREEN ASSESSMENT & CONSULTATION LLC

Practice address

411 E Park St Ste 106
Champaign, IL 61820-3862

Phone

(217) 714-7042

Fax

(866) 216-6514

NPI assigned

Aug 1, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Jonathan William Thomas-Stagg, PSYCHOLOGIST

Title

Owner

Phone

(217) 714-7042

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1690848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690848000000",
    "number": "1467134403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 E PARK ST STE 106",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618203862",
            "telephone_number": "217-714-7042",
            "fax_number": "866-216-6514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 E PARK ST STE 106",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618203862",
            "telephone_number": "217-714-7042",
            "fax_number": "866-216-6514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN ASSESSMENT & CONSULTATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-01",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A",
        "authorized_official_last_name": "THOMAS-STAGG",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-714-7042",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYCHOLOGIST"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Marcus Evans, PA
• Mary K Evans, LPC, MA
• Susan Evans, LCSW
• William Evans, RBT
• Evelyn Marie Moore O.D., P.C.
• Evergreen Coaching and Counseling, Inc.
• Evergreen Coaching and Counseling, Inc.
• Everside Health LLC
• Roger Ewald, M.D.
• Brittany Michelle Ewing

• Clinical Psychologist in Champaign, IL
• Providers in Champaign, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 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.