Evergreen Therapy LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

EVERGREEN THERAPY LLC

Practice address

139 Log Canoe Cir
Stevensville, MD 21666-2127

Phone

(443) 808-1083

NPI assigned

Aug 28, 2023

Organization subpart

No

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

Authorized official

Name

Amy Louise Gibbs Bennett, LGPCNPI 1376140285

Title

Clinical Mental Health Therapist

Phone

(443) 808-1083

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Evergreen Therapy Doing business as

Locations

Practitioners 1

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

• Amy Louise Gibbs Bennett, LCPC, NCC

  • Mental Health Counselor
  • Stevensville, MD
  • NPI 1376140285
  NPD Authorized official

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

{
    "created_epoch": "1693180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1548045859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 LOG CANOE CIR",
            "city": "STEVENSVILLE",
            "state": "MD",
            "postal_code": "216662127",
            "telephone_number": "443-808-1083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 LOG CANOE CIR",
            "city": "STEVENSVILLE",
            "state": "MD",
            "postal_code": "216662127",
            "telephone_number": "443-808-1083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-28",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-26",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "LOUISE GIBBS",
        "authorized_official_title_or_position": "CLINICAL MENTAL HEALTH THERAPIST",
        "authorized_official_telephone_number": "443-808-1083",
        "authorized_official_credential": "LGPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1376140285",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephanie Disque
• Julie Lyn Dixon, L.C.P.C.
• Fariba Djangali, PT
• Deborah Dudas, PT
• Dudley Katz D.D.S.P.C.
• Malley K Hester Everngam, LCSW-C
• Melissa Irene Farrelly, MS, BCBA
• John Earl Fish, D.C
• Maureen Flanagan, SLP
• For All Seasons, Inc

• Mental Health Clinic/Center (Including Community Mental Health Center) in Stevensville, MD
• Providers in Stevensville, MD by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.