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General NPI Number Information
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NPI Number | 1295629806
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Entity Type | Organization
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Legal Business Name | EVERGREEN COUNSELING AND CONSULTATION
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 8855 SW HOLLY LN STE 111
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City | WILSONVILLE
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State | OR
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Zip | 97070-8793
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Country | US
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Telephone | 503-902-8431
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Fax |
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Provider Business Mailing Address
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Address Line | 2822 WALNUT CT
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City | HUBBARD
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State | OR
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Zip | 97032-9692
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Country | US
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Telephone | 219-669-8267
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EVAN MICHAEL LAFOUNTAIN
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Credential | LPC
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Telephone | 219-669-8267
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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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