Healthcare Provider Details

I. General information

NPI: 1407665391
Provider Name (Legal Business Name): EVERGREEN PSYCHOTHERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST STE 203
PASADENA CA
91106-2401
US

IV. Provider business mailing address

PO BOX 251
PASADENA CA
91102-0251
US

V. Phone/Fax

Practice location:
  • Phone: 310-633-1295
  • Fax:
Mailing address:
  • Phone: 310-633-1295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HILLARY SUZANNE WRIGHT
Title or Position: PRESIDENT
Credential: PHD
Phone: 310-633-1295