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General NPI Number Information
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NPI Number | 1972335784
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Entity Type | Organization
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Legal Business Name | EVERGREEN EDUCATIONAL THERAPY LLC
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Dates
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Enumeration Date | 08/19/2024
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 709 E COLORADO BLVD STE 250
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City | PASADENA
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State | CA
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Zip | 91101-2159
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Country | US
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Telephone | 626-214-8972
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Fax | 626-517-5083
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Provider Business Mailing Address
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Address Line | 709 E COLORADO BLVD STE 250
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City | PASADENA
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State | CA
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Zip | 91101-2159
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Country | US
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Telephone | 626-214-8972
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Fax | 626-517-5083
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. AMANDA LEPORE
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Credential | ET/P
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Telephone | 626-977-4211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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