{
"Npi": {
"NPI": "1568667764",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EVERGREEN BEHAVIORAL SERVICES, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 871",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MEXICO",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "65265-0871",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "573-582-0292",
"MailingAddressFaxNumber": "573-581-6036",
"FirstLinePracticeLocationAddress": "116 S JEFFERSON ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MEXICO",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "65265-2842",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "573-582-0292",
"PracticeLocationAddressFaxNumber": "573-581-6036",
"EnumerationDate": "06/18/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FINDER",
"AuthorizedOfficialFirstName": "PATRICK",
"AuthorizedOfficialMiddleName": "G",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.S.",
"AuthorizedOfficialTelephoneNumber": "573-582-0292",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "PYO1319",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}