| Evergreen Coaching & Counseling, Inc. | |
|
411 E Park St Ste 106 Champaign IL 61820-3862 | |
| (217) 714-7042 | |
| (866) 216-6514 |
| Full Name | Evergreen Coaching & Counseling, Inc. |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| 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 Coaching & Counseling, Inc. 411 E Park St Ste 106 Champaign IL 61820-3862 Ph: (217) 714-7042 | Evergreen Coaching & Counseling, Inc. 411 E Park St Ste 106 Champaign IL 61820-3862 Ph: (217) 714-7042 |
| NPI Number | 1265114219 |
|---|---|
| Provider Enumeration Date | 08/01/2023 |
| Last Update Date | 08/28/2023 |
| Certification Date | 08/09/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265114219 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
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