Provider Demographics
NPI:1891680823
Name:EVERGREEN & LAVENDER PRACTICE, PLLC
Entity type:Organization
Organization Name:EVERGREEN & LAVENDER PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:509-843-7041
Mailing Address - Street 1:18121 E HAMPDEN AVE
Mailing Address - Street 2:UNIT C #785
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013
Mailing Address - Country:US
Mailing Address - Phone:970-460-6408
Mailing Address - Fax:
Practice Address - Street 1:3064 S ANDES ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-5720
Practice Address - Country:US
Practice Address - Phone:970-460-6408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)