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General NPI Number Information
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NPI Number | 1114195898
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Entity Type | Organization
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Legal Business Name | THE EVERGREEN STATE COLLEGE
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 02/14/2008
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Provider Practice Location Address
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Address Line | 2700 EVERGREEN PKWY NW SEMINAR 1 2110
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City | OLYMPIA
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State | WA
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Zip | 98505-0005
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Country | US
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Telephone | 360-867-6808
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Fax | 360-867-6787
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Provider Business Mailing Address
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Address Line | 2700 EVERGREEN PKWY NW SEMINAR 1 2110
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City | OLYMPIA
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State | WA
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Zip | 98505-0005
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Country | US
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Telephone | 360-867-6808
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Fax | 360-867-6787
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Authorized Official
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Title or Position | DIRECTOR OF COUNSELING & HEALTH SVC
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Name | ELIZABETH MCHUGH
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Credential | PA-C
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Telephone | 360-867-6808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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