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General NPI Number Information
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NPI Number | 1073594776
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Entity Type | Organization
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Legal Business Name | EVERGREEN COUNSELING CENTER
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 23777 COUNTY ROAD 125
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City | BEDIAS
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State | TX
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Zip | 77831-3373
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Country | US
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Telephone | 832-877-0295
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Fax | 832-295-5752
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Provider Business Mailing Address
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Address Line | 23777 COUNTY ROAD 125
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City | BEDIAS
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State | TX
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Zip | 77831-3373
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Country | US
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Telephone | 832-877-0295
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Fax | 832-295-5752
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. SHIRLEY FAYE SAMMONS-COX
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Credential | LPC, LMFT, LCDC
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Telephone | 832-877-0295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1393
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 02054
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10083
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License Number State | TX
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