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General NPI Number Information
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NPI Number | 1063076859
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Entity Type | Organization
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Legal Business Name | EVERGREEN COUNSELING SA, PLLC
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Dates
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Enumeration Date | 04/26/2019
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 11467 HUEBNER RD STE 251
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City | SAN ANTONIO
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State | TX
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Zip | 78230-1073
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Country | US
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Telephone | 503-389-5504
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Fax |
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Provider Business Mailing Address
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Address Line | 11467 HUEBNER RD STE 251
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City | SAN ANTONIO
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State | TX
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Zip | 78230-1073
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Country | US
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Telephone | 503-389-5504
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMY A KIPP
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Credential | LFMT-S
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Telephone | 503-389-5504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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