Evergreen Behavioral Health Inc.

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

EVERGREEN BEHAVIORAL HEALTH INC.

Doing business as

Evergreen Behavioral Health Inc.

Practice address

1206 SW Main Blvd Ste 103
Lake City, FL 32025-6603

Phone

(386) 487-9979

Fax

(386) 487-9979

NPI assigned

Dec 28, 2023

Last updated

Dec 28, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Joshua Messer, CAP, ICADCNPI 1083109185

Title

Ceo

Phone

(386) 487-9979

Specialties & licenses 1

Addresses

Other names 1

• Evergreen Behavioral Health Inc. 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, and the practitioner matching its NPPES authorized official.

• Joshua T Messer, CAP, ICADC

  • Addiction (Substance Use Disorder) Counselor
  • Lake City, FL
  • NPI 1083109185
  NPD Authorized official

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

{
    "created_epoch": "1703721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703721600000",
    "number": "1932978277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1206 SW MAIN BLVD STE 103",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320256603",
            "telephone_number": "386-487-9979",
            "fax_number": "386-487-9979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1206 SW MAIN BLVD STE 103",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320256603",
            "telephone_number": "386-487-9979",
            "fax_number": "386-487-9979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN BEHAVIORAL HEALTH INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-28",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A",
        "authorized_official_last_name": "MESSER",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "386-487-9979",
        "authorized_official_credential": "CAP, ICADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Behavioral Health Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kristyn Ann Faircloth, LCSW

• Addiction (Substance Use Disorder) Counselor in Lake City, FL
• Providers in Lake City, FL by specialty
• Addiction (Substance Use Disorder) Counselor in Florida

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