Healthcare Provider Details

I. General information

NPI: 1093646994
Provider Name (Legal Business Name): EVERGREEN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1283 FIELDSTONE DR
SAUK RAPIDS MN
56379-2584
US

IV. Provider business mailing address

1283 FIELDSTONE DR
SAUK RAPIDS MN
56379-2584
US

V. Phone/Fax

Practice location:
  • Phone: 320-266-7563
  • Fax:
Mailing address:
  • Phone: 320-266-7563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LACIE GLASSER
Title or Position: OWNER / PSYCHOTHERAPIST
Credential: LPCC
Phone: 320-266-7563