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General NPI Number Information
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NPI Number | 1205593449
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Entity Type | Organization
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Legal Business Name | EVERGREEN TELEPSYCHIATRY PLLC
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Dates
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Enumeration Date | 11/23/2021
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 11335 NE 122ND WAY STE 105
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City | KIRKLAND
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State | WA
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Zip | 98034-6933
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Country | US
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Telephone | 206-451-7150
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Fax |
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Provider Business Mailing Address
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Address Line | 11335 NE 122ND WAY STE 105
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City | KIRKLAND
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State | WA
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Zip | 98034-6933
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Country | US
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Telephone | 206-451-7150
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Fax |
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Authorized Official
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Title or Position | FOUNDER/PMHNP-BC
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Name | JOSEPH MICHAEL UNGVARSKY
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Credential |
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Telephone | 570-417-3318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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