Organization
EVERGREEN PSYCHOLOGICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDALL A. YOUNG MA, LMHC, LICDC, MAC (VICE PRESIDENT/BUSINESS ADMINISTRAT)
(317) 520-4650
Entity
Organization
Contact information
Practice address
1155 PARKWAY DR. STE 200, ZIONSVILLE, IN 46077-8541
(317) 520-4650
Mailing address
1155 PARKWAY DR. STE 200, ZIONSVILLE, IN 46077-8541
(317) 520-4650
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
39001948A
IN
103TC0700X
Clinical Psychologist
Primary
20042335A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201002540
—
IN
Enumeration date
01/06/2017
Last updated
04/11/2017
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