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General NPI Number Information
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NPI Number | 1407665391
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Entity Type | Organization
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Legal Business Name | EVERGREEN PSYCHOTHERAPY SERVICES
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 960 E GREEN ST STE 203
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City | PASADENA
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State | CA
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Zip | 91106-2401
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Country | US
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Telephone | 310-633-1295
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 251
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City | PASADENA
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State | CA
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Zip | 91102-0251
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Country | US
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Telephone | 310-633-1295
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HILLARY SUZANNE WRIGHT
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Credential | PHD
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Telephone | 310-633-1295
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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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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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