Organization
EVERGREEN THERAPY, PLLC
Active
Organization
EVERGREEN THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOBETH MUSICK LCSW (MEMBER)
(501) 425-4039
Entity
Organization
Contact information
Practice address
7514 HIGHWAY 107, SHERWOOD, AR 72120-7212
(501) 392-6681
Mailing address
1101 WINNEBAGO DR, NORTH LITTLE ROCK, AR 72116-4350
(501) 425-4039
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306194485
—
AR
05
—
1659722528
—
AR
Enumeration date
02/28/2023
Last updated
02/28/2023
Update your record
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