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General NPI Number Information
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NPI Number | 1932814662
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Entity Type | Organization
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Legal Business Name | EVERGREEN THERAPY LLC
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Dates
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Enumeration Date | 01/17/2023
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 2900 S 70TH ST STE 160
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City | LINCOLN
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State | NE
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Zip | 68506-3733
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Country | US
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Telephone | 402-318-7949
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 S 70TH ST STE 160
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City | LINCOLN
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State | NE
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Zip | 68506-3733
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Country | US
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Telephone | 402-401-7560
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Fax |
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Authorized Official
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Title or Position | DIRECT OWNER
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Name | JONAE N CUNNINGHAM
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Credential | LIMHP
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Telephone | 402-401-7560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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