Emily Evergreen

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MC61525570 Issued in WA

Practice address

2124 Riverside Dr Ste 210
Mount Vernon, WA 98273-5454

Phone

(360) 230-8424

NPI assigned

Aug 22, 2024

Last updated

Aug 22, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lighthouse Counseling & Wellness, PLLC

  dba Lighthouse Counseling & Wellness

  • Adult Mental Health Clinic/Center
  • Mount Vernon, WA
  • NPI 1336998970
  NPD Authorized official

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

{
    "created_epoch": "1724284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724284800000",
    "number": "1841023033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2124 RIVERSIDE DR STE 210",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982735454",
            "telephone_number": "360-230-8424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2124 RIVERSIDE DR STE 210",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982735454",
            "telephone_number": "360-230-8424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVERGREEN",
        "first_name": "EMILY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-22",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC61525570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kailey Breanne Faber
• Family Care Network PLLC (Family Care Network Mount Vernon Family Health)
• Family Care Network PLLC (FCN Urgent Care - Mount Vernon)

• Mental Health Counselor in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; 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.