MEDICARE: EVERGREEN CLINICAL MENTAL HEALTH COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1851253314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERGREEN CLINICAL MENTAL HEALTH COUNSELING LLC

Provider Business Mailing Address
First Line	:	1130 W COOK RD
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-3516
Country	:	US
Telephone Number	:	419-777-5515
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 W COOK RD
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-3516
Country	:	US
Telephone Number	:	419-777-5515
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MATTHEW HOWE
Credential	:	MA, LPCC, ICP
Telephone Number	:	419-777-5515

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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