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
—
—
Other
Enumeration date
12/03/2020
Last updated
12/03/2020
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