Organization
EVERGREEN COUNSELING SA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY A KIPP LFMT-S (PRESIDENT)
(503) 389-5504
Entity
Organization
Contact information
Practice address
11467 HUEBNER RD STE 251, SAN ANTONIO, TX 78230-1073
(503) 389-5504
Mailing address
11467 HUEBNER RD STE 251, SAN ANTONIO, TX 78230-1073
(503) 389-5504
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12684503
CAQH
—
Enumeration date
04/26/2019
Last updated
04/26/2019
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