| Evergreen Assessment & Consultation Llc | |
|
411 E Park St Ste 106 Champaign IL 61820-3862 | |
| (217) 714-7042 | |
| (866) 216-6514 |
| Full Name | Evergreen Assessment & Consultation Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 411 E Park St Ste 106, Champaign, Illinois |
| Authorized Official Name and Position | Jonathan William Thomas-stagg (OWNER) |
| Authorized Official Contact | 2177147042 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Assessment & Consultation Llc 411 E Park St Ste 106 Champaign IL 61820-3862 Ph: (217) 714-7042 | Evergreen Assessment & Consultation Llc 411 E Park St Ste 106 Champaign IL 61820-3862 Ph: (217) 714-7042 |
| NPI Number | 1467134403 |
|---|---|
| Provider Enumeration Date | 08/01/2023 |
| Last Update Date | 08/01/2023 |
| Certification Date | 08/01/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467134403 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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