Healthcare Provider Details

I. General information

NPI: 1861310724
Provider Name (Legal Business Name): EVERGREEN PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 S COLLEGE AVE UNIT 210
FORT COLLINS CO
80525-2557
US

IV. Provider business mailing address

3030 S COLLEGE AVE UNIT 210
FORT COLLINS CO
80525-2557
US

V. Phone/Fax

Practice location:
  • Phone: 970-682-3191
  • Fax:
Mailing address:
  • Phone: 970-682-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KIRSTEN L GRAHAM
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD
Phone: 970-682-3191