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General NPI Number Information
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NPI Number | 1558227173
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Entity Type | Organization
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Legal Business Name | EVERGROVE THERAPY LLC
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 5442 MAJESTIC DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-3540
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Country | US
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Telephone | 214-732-2497
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Fax |
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Provider Business Mailing Address
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Address Line | 5442 MAJESTIC DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-3540
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RYAN ANDREA MARTINEZ
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Credential | BCBA
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Telephone | 214-732-2497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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