Provider Demographics
NPI:1861154437
Name:EVERGREEN PSYCHOLOGY, PLLC
Entity type:Organization
Organization Name:EVERGREEN PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MENG
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:425-405-0648
Mailing Address - Street 1:12345 LAKE CITY WAY NE # 2022
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5401
Mailing Address - Country:US
Mailing Address - Phone:425-405-0648
Mailing Address - Fax:206-363-8271
Practice Address - Street 1:7389 25TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5801
Practice Address - Country:US
Practice Address - Phone:202-230-8086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty