Healthcare Provider Details

I. General information

NPI: 1275454829
Provider Name (Legal Business Name): EVERGREEN COAST THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4456 LOGAN DR NE
LACEY WA
98516-1351
US

IV. Provider business mailing address

4456 LOGAN DR NE
LACEY WA
98516-1351
US

V. Phone/Fax

Practice location:
  • Phone: 571-384-8239
  • Fax:
Mailing address:
  • Phone: 571-384-8239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NATALIE WHITE
Title or Position: MANAGING MEMBER
Credential: LCSW
Phone: 571-384-8239