Healthcare Provider Details

I. General information

NPI: 1295657468
Provider Name (Legal Business Name): EVERGREEN BEHAVIOR SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61357 ELKHORN ST
BEND OR
97702-3957
US

IV. Provider business mailing address

61357 ELKHORN ST
BEND OR
97702-3957
US

V. Phone/Fax

Practice location:
  • Phone: 714-928-0468
  • Fax:
Mailing address:
  • Phone: 541-224-6804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAYLEE ENGELDER
Title or Position: OWNER
Credential: MS, BCBA, LBA
Phone: 541-224-6804