Provider Demographics
NPI:1609681931
Name:EVERGREEN THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:EVERGREEN THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-619-6855
Mailing Address - Street 1:1605 N ANKENY BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4163
Mailing Address - Country:US
Mailing Address - Phone:515-619-6855
Mailing Address - Fax:
Practice Address - Street 1:1605 N ANKENY BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4163
Practice Address - Country:US
Practice Address - Phone:515-619-6855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA107268OtherIOWA DEPT. OF PUBLIC HEALTH / BOARD OF SOCIAL WORK