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Organization

EVERGREEN PSYCHOLOGICAL SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. THOMAS POTTER PH.D. (PSYCHOLOGIST)
(641) 670-0388
Entity
Organization

Contact information

Practice address
313 COLLEGE AVE, OSKALOOSA, IA 52577-1700
(641) 670-0388
Mailing address
313 COLLEGE AVE, OSKALOOSA, IA 52577-1700
(641) 670-0388

Taxonomy

Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1982760070
IA
Enumeration date
02/27/2010
Last updated
02/27/2010
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