Organization
EVERGREEN COACHING AND COUNSELING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN WILLIAM THOMAS-STAGG PH.D. (PRESIDENT/PSYCHOLOGIST)
(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, CHAMPAIGN, IL 61820-3841
(217) 714-7042
(866) 216-6514
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
01/04/2019
Last updated
08/22/2023
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