| Evergreen Psychological Services, Llc | |
|
1155 Parkway Dr. Ste 200 Zionsville IN 46077-8541 | |
| (317) 520-4650 | |
| Not Available |
| Full Name | Evergreen Psychological Services, Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1155 Parkway Dr. Ste 200, Zionsville, Indiana |
| Authorized Official Name and Position | Randall A. Young (VICE PRESIDENT/BUSINESS ADMINISTRAT) |
| Authorized Official Contact | 3175204650 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Psychological Services, Llc 1155 Parkway Dr. Ste 200 Zionsville IN 46077-8541 Ph: (317) 520-4650 | Evergreen Psychological Services, Llc 1155 Parkway Dr. Ste 200 Zionsville IN 46077-8541 Ph: (317) 520-4650 |
| NPI Number | 1639615206 |
|---|---|
| Provider Enumeration Date | 01/06/2017 |
| Last Update Date | 04/11/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639615206 | NPI | - | NPPES |
| 201002540 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 39001948A (Indiana) | Secondary |
| 103TC0700X | Psychologist - Clinical | 20042335A (Indiana) | Primary |
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