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General NPI Number Information
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NPI Number | 1013717859
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Entity Type | Organization
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Legal Business Name | EVERGREEN FAMILY SERVICES LLC
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 1371 SAGEBERRY DR
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City | SANTAQUIN
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State | UT
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Zip | 84655-5622
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Country | US
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Telephone | 385-392-5605
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Fax |
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Provider Business Mailing Address
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Address Line | 1371 SAGEBERRY DR
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City | SANTAQUIN
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State | UT
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Zip | 84655-5622
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Country | US
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Telephone | 385-392-5605
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERIKA CAIN
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Credential | LCSW
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Telephone | 385-392-5605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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