Organization
EVERGREEN MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REGINA DAVIS ARNP (OWNER)
(509) 992-4224
Entity
Organization
Contact information
Practice address
23403 E MISSION AVE STE 200I, LIBERTY LAKE, WA 99019-7575
(509) 992-4224
Mailing address
PO BOX 333, LIBERTY LAKE, WA 99019-0333
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP60654992
WA
Other
Enumeration date
04/27/2017
Last updated
03/19/2019
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