| Evergreen Mental Health & Assessment, Llc | |
|
4758 Lynnville Way Clay NY 13041-8990 | |
| (240) 274-0012 | |
| Not Available |
| Full Name | Evergreen Mental Health & Assessment, Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 4758 Lynnville Way, Clay, New York |
| Authorized Official Name and Position | Alexander Joseph Hinnebusch (OWNER) |
| Authorized Official Contact | 2402740012 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Mental Health & Assessment, Llc 4758 Lynnville Way Clay NY 13041-8990 Ph: (240) 274-0012 | Evergreen Mental Health & Assessment, Llc 4758 Lynnville Way Clay NY 13041-8990 Ph: (240) 274-0012 |
| NPI Number | 1073225090 |
|---|---|
| Provider Enumeration Date | 12/21/2022 |
| Last Update Date | 12/21/2022 |
| Certification Date | 12/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073225090 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |