Evergreen Psychiatry, LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

60564652 Issued in WA

Legal business name

EVERGREEN PSYCHIATRY, LLC

Practice address

801 Samish Way
Bellingham, WA 98229-2901

Phone

(360) 255-2505

NPI assigned

Aug 8, 2016

Organization subpart

No

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

Authorized official

Name

Amber Kostial, MD

Title

Owner/Operator

Phone

(801) 635-9580

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1470614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470614400000",
    "number": "1669926556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 SAMISH WAY",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982292901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 SAMISH WAY",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982292901",
            "telephone_number": "360-255-2505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PSYCHIATRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-08",
        "last_updated": "2016-08-08",
        "status": "A",
        "authorized_official_last_name": "KOSTIAL",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "801-635-9580",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "60564652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Bellingham, WA
• Providers in Bellingham, WA by specialty
• Psychiatry Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2016; 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.