MEDICARE: EVERGREEN CENTER FOR COUNSELING, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1861497059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERGREEN CENTER FOR COUNSELING, INC

Provider Business Mailing Address
First Line	:	1135 W CHERRY AVE
Second Line	:
City	:	SELMER
State	:	TN
Zip	:	38375-5001
Country	:	US
Telephone Number	:	731-645-8813
Fax Number	:	731-645-8814

Provider Business Practice Location Address
First Line	:	1135 W CHERRY AVE
Second Line	:
City	:	SELMER
State	:	TN
Zip	:	38375-5001
Country	:	US
Telephone Number	:	731-645-8813
Fax Number	:	731-645-8814

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN R REEVES
Credential	:	MSW
Telephone Number	:	731-645-8813

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	08/22/2020

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