THE EVERGREEN CLINIC (NPI# 1447314539) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447314539 |
| Entity Type | Organization |
| Organization Name | THE EVERGREEN CLINIC |
| Practice Address |
12025 115th Ave Ne #200 Kirkland WA 98034 |
| Practice Telephone | 4258211810 |
| Practice Fax Number | 4258231231 |
| Mailing Telephone | 4258211810 |
| Mailing Fax Number | 4258231231 |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2015-04-27 |
| Authorized Official Name | ANNE R. LUCAS (OWNER) |
| Authorized Official Telephone | 4258211810 |
| Authorized Official Credential | LMHC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
601889816 | WA | Allopathic & Osteopathic Physicians |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | THE EVERGREEN CLINIC, PLLC | 12025 115th Ave Ne Ste 200, Kirkland, WA 98034-6935 |
| Street Address |
12025 115TH AVE NE #200 |
| City | KIRKLAND |
| State | WA |
| Zip Code | 98034 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992189328 | Timothy James Peterson | Counselor | 12025 115th Ave Ne, Bldg D Suite 200, Kirkland, WA 98034-6942 | 2015-07-15 |
| 1174900898 | Antoinette Evans | Marriage & Family Therapist | 12025 115th Ave Ne, D 200, Kirkland, WA 98034-6942 | 2015-05-01 |
| 1033465182 | Adam Robinson Johns | Marriage & Family Therapist | 12025 115th Ave Ne, Building D, Ste 200, Kirkland, WA 98034-6942 | 2012-07-26 |
| 1760548978 | Robert Christopher Cotner | Naturopath | 12025 115th Ave Ne, Suite 200, Kirkland, WA 98034-6942 | 2006-12-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578116596 | Rachel Bowers | Behavior Technician | 1335 Northeast 122nd Way, Suite 105, Kirkland, WA 98034 | 2019-07-18 |
| 1740841048 | Kristina Louise Inghram | Behavior Technician | 11415 Ne 128th St., Suite 40, Kirkland, WA 98034 | 2019-06-26 |
| 1053978064 | Matthew A. Bagnulo, Dds, Ps | Dentist | 11830 Ne 128th St., #202, Kirkland, WA 98034 | 2019-05-24 |
| 1629568928 | Stephanie Michalko | Optometrist | 11800 Ne 128th St Ste 110, Kirkland, WA 98034 | 2018-05-14 |
| 1952800013 | Heath Family Counseling LLC | Marriage & Family Therapist | 12025 115th Ave. Ne, Building D, Ste 200, Kirkland, WA 98034 | 2018-02-05 |
| 1891202834 | Barbara Josephine Gorham | Counselor | 2025 115th Ave Ne, Bldg D, #200, Kirkland, WA 98034 | 2017-12-29 |
| 1548782915 | Eleanor Hollis Wall | Counselor | 14340 102nd Ave Ne, Kirkland, WA 98034 | 2017-07-07 |
| 1457885212 | Peter Schoonmaker | Hospitalist | 12040 Ne 128th Street, Ms105, Kirkland, WA 98034 | 2017-04-18 |
| 1780124370 | Rebecca Managan | Advanced Practice Midwife | 12303 Ne 130th Ln Ste Coral225, Kirkland, WA 98034 | 2017-03-01 |
| 1669821104 | Winter Gonzalez | Counselor | 11720 97th Ln Ne Apt A411, Kirkland, WA 98034 | 2016-06-06 |
| Find all providers in zip 98034 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770941874 | Eastside Psychiatry | Psychiatry & Neurology | 6025 108th Ave Ne, Kirkland, WA 98033-7241 | 2016-02-03 |
| 1922278167 | William W Adams Md Ps | Psychiatry & Neurology | 10235 Ne 58th St, Kirkland, WA 98033-7440 | 2008-03-04 |
| 1104036631 | Sid H Siahpush | Psychiatry & Neurology | 12025 115th Ave Ne, Building D, Ste 200, Kirkland, WA 98034-2831 | 2007-05-23 |
| 1790903318 | Lynne A Wilk | Psychiatry & Neurology | 11411 Ne 124th St #190, Kirkland, WA 98034-4318 | 2007-04-20 |
| 1912121625 | Michael D. Ward | Psychiatry & Neurology | 11416 Slater Ave Ne Ste 204, Kirkland, WA 98033-8817 | 2007-04-12 |
| 1568589448 | Ilhan Conklu | Psychiatry & Neurology | 10315 Ne 126th Pl, Kirkland, WA 98034-2895 | 2007-03-23 |
| 1730223348 | Timothy Alan Rogge | Psychiatry & Neurology | 13128 Totem Lk Blvd, Suite 206, Kirkland, WA 98034 | 2007-02-16 |
| 1114036381 | Elizabeth Alexandra Ashleigh | Psychiatry & Neurology | 823 3rd St, Kirkland, WA 98033-5540 | 2006-08-30 |
| 1689683583 | Donald E Rice | Psychiatry & Neurology | 830 6th St S, Kirkland, WA 98033-6714 | 2006-08-07 |
| 1356350748 | Tamara Zundel | Psychiatry & Neurology | 10126 Ne 132nd St Ste C, Kirkland, WA 98034-9043 | 2006-08-05 |
| Find all providers in KIRKLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.