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Organization

EVERGREEN ASSESSMENT & CONSULTATION LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JONATHAN WILLIAM THOMAS-STAGG PSYCHOLOGIST (OWNER)
(217) 714-7042
Entity
Organization

Contact information

Practice address
411 E PARK ST STE 106, CHAMPAIGN, IL 61820-3862
(217) 714-7042
(866) 216-6514
Mailing address
411 E PARK ST STE 106, CHAMPAIGN, IL 61820-3862
(217) 714-7042
(866) 216-6514

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary

Other

Enumeration date
08/01/2023
Last updated
08/01/2023
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