Organization
EVERGREEN PSYCHOLOGICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EVAN LIMA PHD (OWNER)
(360) 347-6172
Entity
Organization
Contact information
Practice address
1930 BLACK LAKE BLVD SW # 102, OLYMPIA, WA 98512-5651
(360) 347-6172
(360) 350-4619
Mailing address
1930 BLACK LAKE BLVD SW # 102, OLYMPIA, WA 98512-5651
(360) 347-6172
(360) 350-4619
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
01/21/2022
Last updated
01/21/2022
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