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Organization
EVERGREEN MENTAL HEALTH AND WELLNESS LLC
Active
Organization
EVERGREEN MENTAL HEALTH AND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RACHEL SPENCER IVANOV RN (PRESIDENT)
(512) 591-6841
Entity
Organization
Contact information
Practice address
13168 MILL STONE DR, AUSTIN, TX 78729-2727
(512) 591-6841
Mailing address
13168 MILL STONE DR, AUSTIN, TX 78729-2727
(512) 591-6841
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
—
NULL
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
—
—
Other
Enumeration date
12/03/2020
Last updated
12/03/2020
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